PRO regein 5 Ac 439(1)Hz3 Tmt lsilwment HES 41 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE BOROUGH OF HESTON AND ISLEWORTH for the year 1954 % ;! A. ANDERSON, M.D., D.P.H., Medical Officer of Health. INDEX Page Page Accidents 6 Medical Examinations of Staff 29 Bakehouses 24 Meteorology 37 Births, Live 5 Milk 23 Births, Still 6 Mosquitoes 21 Burials 29 Municipal Restaurants and School Canteens 24 Canal Boats 21 Noise Nuisances 21 Closet Accommodation 16 Nutrition 26 Common Lodging Houses 21 Persons in need of care and attention 29 Deaths 6 Pet Animals Act, 1951 23 Deaths, Age and Sex Distribution 33 Physical Characteristics 15 Deaths, Causes of 31 Public Cleansing 16 Disinfection 12 Public Mortuary 29 Disinfestation 21 Rags, etc., Exchange of Articles for 18 Drainage and Sewerage 15 Rag Flock and Other Filling Materials Act, 1951 22 Factories, No. on Register, Inspections and Defects, etc. 39 Rats and Mice Destruction 22 factories, Workplaces, etc. 21 Rivers and Streams 16 Fever Hospitals 12 Sanitary Circumstances 15 Food and Drugs Sampling 24 Sanitary Inspection 17 Food Hygiene 25 Shops Act, 1950, Section 38 22 Food Ioisoning 12 Slaughter of Animals Act, 1933 24 Health Committee 3 Slaughterhouses, etc. 24 Health Education 29 Smoke Abatement and Atmospheric Health Services provided by Other Authorities 13 Pollution Housing 26 2 Ice Cream 23 Statistics, Certain Vital, County of Middlesex 36 intant Deaths according to Age and Cause 32 Infant Mortality 9 Statistics General Infectious Diseases 10 Statistics Vital 5 Infectious Diseases, Age Distribution 34 Statistics, Vital, Summary of 30 Infectious Diseases, Notifications and Swimming Baths Deaths 35 Tents, Vans and Caravans 21 laboratory Service 12 Tuberculosis 11 Laundry Service 29 Verminous Premises, Articles and Persons 23 Maternal Mortality 10 Water Supp|y 15 Meat and Other Food Inspection 24 STAFF Medical Officer of Health (part-time) A. Anderson, M.D., D.P.H. Deputy Medical Officer of Health (part-time) W. Paterson, M.B., Ch.B., D.P.H. (to 13.6.54). E. N. Christie, M.B., Ch.B., D.P.H. (from 5.7.54). Chief Sanitary Inspector. A. B. Hauldren, Cert, as S.I. and M.I. Deputy Chief Sanitary Inspector. K. J. Smith, Cert, as S.I. and M.I. District Sanitary Inspectors. G. Latimer, Cert, as S.I. and M.I. S. H. G. Stevens, Cert, as S.I., M.I. and S.E. J. A. Dawson, Cert, as S.I. and M.I. W. Bowles, Cert, as S.I. and M.I. P. G. T. Woods, Cert, as S.I. and M.I. J. K. Edson, Cert, as S.I., M.I. and San. Science. L. Howarth, Cert, as S.I. and M.I. Rodent Officer. A. Farrer. Rodent Operatives. R. Ashurst. R. B. Denyer. Mortuary Attendants, Disinfectors, Drain Testers, et.. F. S. J. Allaway. C. J. Scott (to 4.2.54). G. Matthews (from 22.2.54). Clerks. B. W. Kilby, Cert, as S.I. and M.I. (part-time). Mrs. L. R. Butler, Cert, as S.I. D. S. Bates. E. J. Hutchins. Miss P. M. Whittington. Mrs. IC. M. Richards. F. B. Capes (to 1.9.54). A. C. Rogers (from 13.9.54). * 2 THE HEALTH COMMITTEE of HESTON AND ISLEWORTH BOROUGH COUNCIL to May, 1954 Alderman Mrs. O. C. M. Denton (Chairman). Councillor Mrs. M. Hennig (Vice-Chairman). Alderman D. C. L. Usher, J.P. (Mayor). Councillor F. J. Jansen. Alderman J. E. Dillingham. Councillor G. K. Roberts. Councillor A. G. Cross. Councillor J. Theobald. Councillor J. Curwood. Councillor J. F. Thomas. Councillor H. J. Davis. Councillor Mrs. M. J. Tozer. Councillor C. W. Elliott. Councillor Miss M. K. Watson, J.P. from May, 1954 Alderman Mrs. O. C. M. Denton (Chairman). Councillor Mrs. M. Hennig (Vice-Chairman). Alderman Mrs. M. F. Davison, J.P. (Mayor). Councillor F. J. Jansen. Alderman J. E. Dillingham. Councillor Mrs. R. New. Councillor A. G. Cross. Councillor G. K. Roberts. Councillor J. Curwood. Councillor Mrs. M. J. Tozer Councillor H. J. Davis. Councillor C. J. Van Ryne. Councillor A. F. Greenfield. Councillor Miss M. K. Watson, J.P. 3 PUBLIC HEALTH DEPARTMENT, 92, BATH ROAD, HOUNSLOW. To the Mayor, Aldermen and Councillors of the Borough of Heston and Isleworth, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1954. The report has been prepared on the lines suggested by the Ministry of Health and for convenience the larger statistical tables have been grouped together at the end of the report. The birth rate was the lowest in the Borough records and the death rate remained at the generally low level of recent years. The incidence of infectious disease was low and for the first time since 1943 no case of poliomyelitis was notified. It is to be regretted that parents are not making better use of the free facilities for the vaccination and immunisation of their children. The infant mortality rate showed a considerable rise as compared with the previous three years. If this rate is to be kept under control, continued effort must be applied to protecting young babies from infection and to the search for measures to reduce prematurity, birth asphyxia and birth injuries. The work of the Department in regard to housing, nuisances, environmental conditions and food hygiene continued. The day-to-day attention to these matters presents no highlights and seldom catches the public eye. The cumulative effect can best be appreciated by comparing conditions today with those existing, say, at the beginning of the century. Such backward glances provide encouragement for the staff concerned and a stimulus to continue where immediate results cannot always be seen. The reports of Government Departments show that illness, by loss of production and cost of treatment, places a very heavy burden on the community. This is a matter of special importance in a country whose standard of living is dependent on its production capacity. Attention must be given not only to the causes of death, but to those conditions producing temporary and chronic ill-health. Health can be described as physical and mental well-being and the importance of the latter is being realised more and more. Advances have been made and many admissions to mental hospitals are now only temporary. The volume of mental ill-health of such a nature as not to require admission to hospital is considerable and is often of the nature of disorders of human relationships. It is being appreciated to an increasing extent that our capacity to live and work in harmonious relations with others is influenced largely by the circumstances of our upbringing during the formative years of childhood. A good home environment and a firm and stable family background provide the right conditions in childhood for the development of sound human relationships and social responsibility. A little thought by most of us will show that our adult attitudes to many aspects of life are coloured by our childhood experience. Here is a growing field for preventive work requiring the full co-operation of parents and the medical and teaching professions. Here, as in other health matters, progress comes not from Acts of Parliament, but. from the desire and acceptance of responsibility by the citizens individually and collectively. I have pleasure in thanking all other Departments for their generous co-operation. The loyal and willing assistance given by all members of my staff has been of great value and I would like to thank the Council for their encouragement and support. I remain, Your obedient servant, A. ANDERSON, Medical Officer of Health. 4 GENERAL STATISTICS 1953 1954 Area in acres 7,218 7,218 Population (Registrar-General's estimate) 105,100 105.600 Number of inhabited houses (ratebooks) 29,090 29,308 Number of houses erected during year 371 218 Rateable Value of Borough £1,030,335 £1,046,998 Sum represented by a penny rate £4,183 £4,260 Live Births—male 675 582 Live Births—female 593 603 Birth rate per 1,000 population 12.1 11.2 Birth rate per 1,000 population (England and Wales) 15.5 15.2 Stillbirths—male 13 12 Stillbirths—female 11 12 Stillbirths Rate per 1.000 (live and still) births 18.6 19.9 Deaths—male 552 529 Deaths—female 514 489 Death rate per 1,000 population 10.1 9.6 Death rate per 1,000 population (England and Wales) 11.4 11.3 Infant Mortality rate 18.1 26.1 Infant Mortality rate (England and Wales) 26.8 25.5 Maternal Mortality rate 0.8 0.0 Maternal Mortality rate (England and Wales) 0.8 0.7 VITAL STATISTICS Population.--The Registrar-General's mid-year estimate of the population of the Borough for the year 1954 is 105,600. In the report for 1953 it was noted that the percentage of persons aged 70 years and over in the Borough population had risen from 3.4 per cent, at the 1901 census to 6.2 per ccnt. at the 1951 census The Chief Medical Officer of the Ministry of Health, commenting on the age distribution of the population, states in his annual report for 1953 :— " One of the commonly held falacies is that as time goes on the proportion of the population in the normal working ages will be materially reduced. While this proportion may in fact become slightly smaller, the main long-term change to be expected is that there will be on the one hand more old people and on the other, fewer children in the population. We are in fact approaching the age distribution to be expected in a stationary population with relatively low mortality. One factor contributing to the changes in age distribution is the rapid decline in the birth rate since the beginning of the century and its recent tendency to settle at a level just sufficient for each generation to replace itself. The other main factors are the greatiy increased expectation of life of the infant at birth, the contemporaneous and accelerated fall in the infant mortality rate and the remarkable decline in mortality among children at later years. Under the conditions ruling in 1838-54, a male infant at birth might have been expected to live rather less than 40 years. By the period 1871-80, his expectation of life had increased to 41.4 years. Between the periods 1881-90 and 1910-12, it again increased to 49.2 years and between 1920 and 19:52 to an expectation of more than 67 years of life. This does not mean, however, that old people are living much longer, and any impression that they are, is a further misconception which is not borne out by the statistics. Considering the expectation of life of males again, we find that the expectation of life at 65 years of age was 10.8 years in 1838-54 and 12.0 years in 1952. Thus old people are not living appreciably longer. What is happening is that many more of us are now attaining the age of 65 than was the case formerly and it is only in this sense that we are becoming an older population; we are still a very long way from becoming a nation of centenarians." Rateable Value.—The rateable value of the Borough for 1954 was £1,046,998 and the sum represented by a penny rate was £4,260. Inhabited Houses. —According to the rate books, the number of inhabited houses at the end of the year was 29,308. In relation to the estimated population, this yields an average of approximately 4 persons per house. Live Births.—The number of live births in 1954 was 1,185 as compared with 1,268 in 1953. The birth rate was 11.2 per 1,000 population. The birth rate will vary, apart from other causes, according to the age and sex distribution of the population, and to permit of a true comparison with other areas, the Registrar-General supplies for each local sanitary authority what is called the area comparability factor. When this is applied to the above Borough birth rate, the result is 11.1 as compared with the birth rate of 15.2 per 1,000 population for England and Wales. The number of illegitimate births was 43, as compared with 49 in 1953. The proportion of live births which were illegitimate, expressed as a percentage of the total live births, is shown below for recent years 1925-29 3.9 1950 4.1 1930-34 3.2 1951 3.6 1935-39 2.9 1952 4.9 1940_44 4.6 1953 3.9 1945_49 5.1 1954 3.6 The majority of births continue to occur in hospital. 5 Stillbirths.— The number of stillbirths in 1954 was 24 (22 legitimate, 2 illegitimate). The proportion of stillbirths per 1,000 total (live and still) births in recent years is shown below:— No. of Stillbirths Rate per 1,000 total births 1930-34 214 31.2 1935-39 224 29.4 1940-44 200 27.7 1945-49 198 23.8 1950 23 18.0 1951 25 20.4 1952 33 25.9 1953 24 18.6 1954 24 19.8 Deaths.— The deaths of residents of the Borough during 1954 were 1,018 (529 male, 489 female). This represents a death rate for the Borough of 9.6 per 1,000 population. The deaths in any area are iniluenced by the sex and age distribution of the population, and to permit .of a true comparison, the Registrar-General calculates for each local sanitary authority area what is called an area comparability factor. When this is applied to the above Borough rate, the result is 9.9 as compared with a death rate of 11.3 per 1,000 population for England and Wales. The Registrar-General has classified the deaths registered during the year, and the details are given in Table II. In Table IV, the deaths occurring during the year have been classified on local information. To help in classifying causes of death, the Registrar-General may obtain additional information which is not available to the Medical Officer of Health. For these two reasons, discrepancies may be noticed on comparing Tables II and IV. The cause of death was certified by the Coroner in 187 cases. A progressive change is taking place in the percentage age distribution of deaths, and this is shown in the following table: — 1910-14 1945-49 1952 1953 1954 Under 1 year 21.8 5.3 2.15 2.16 3.03 1 -4 years 8.4 0.8 0.74 0.09 0.67 5-14 years 3.8 2.1 0.18 0.56 0.20 15-24 years 3.7 2.1 0.84 0.47 0.88 25-64 years 30.8 33.0 31.11 29.91 30.83 65 years and over 31.5 56.7 64.48 66.79 64.39 The chief causes of death in males were heart and circulatory diseases (165), cancer (104), bronchitis and pneumonia (55) and cerebral haemorrhage (53). In females, the chief causes of death were heart and circulatory diseases (158), cancer (110), cerebral haemorrhage (69), and bronchitis and pneumonia (38). Cancer of the lung continues to take an increasing toll of life. The deaths of Borough residents from pulmonary tuberculosis and cancer of the lung during the last ten years are shown below Pulmonary Tuberculosis Cancer of the Lung Male Female Male Female 1945 26 17 19 6 1946 25 21 31 9 1947 26 21 13 9 1948 22 13 23 6 1949 22 10 35 6 1950 21 15 24 4 1951 18 8 34 4 1952 8 8 27 5 1953 9 1 41 6 1954 8 4 45 4 185 118 292 59 Cancer of the lung is now in males a greater killer than pulmonary tuberculosis and if the reduction in tuberculosis deaths continues, the same may soon be true of females. The great difference in the sex incidence of cancer of the lung is still unexplained. Nothing has occurred to refute the evidence that tobacco smoking is a factor in the production of cancer of the lung, though the nature of its influence has yet to be discovered. Attention is also being given to the possible influence ot contamination of the air by the products of coal and oil combustion. The Secretary of the Road Safety Committee informs me that during 1954 there were 549 road accidents which resulted in 16 deaths, serious injury to 117 persons, and slight injury to 559 persons The number of deaths from road traffic accidents and other accidents in Borough residents during the last ten years is shown opposite:— b DEATHS UNDER / YEAR OF AGE PER 1000 LIVE BIRTHS DEATHS UNDER / WEEK OF AGE PER 1000 LIVE BIRTHS STILLBIRTHS PER /OOO TOTAL (LIVE AND STILL) BIRTHS 7 DEATHS UNDER / YEAR OF ACE DUE TO INFECTIOUS AND NUTRITIONAL DISORDERS PER J000 LIVE BIRTHS _ DEATHS UNDER / YEAR OF ACE DUE TO OTHER CAUSES PER J000 LIVE BIRTHS 8 Year Road Traffic Other Accidents Age in years Age in years All ages 0-4 5-14 15-64 65+ All ages 0-4 5-14 15-64 65+ 1945 1 7 3 11 2 10 15 27 1946 — 2 9 1 12 5 2 8 17 32 1947 — — 10 2 12 1 — 12 20 33 1948 — — 8 2 10 2 2 10 14 28 1949 1 2 6 5 14 2 — 9 8 19 1950 2 3 8 7 20 2 1 6 17 26 1951 - — 9 3 12 — 1 4 13 18 1952 - 1 3 7 11 — —. 3 12 15 1953 - — 9 8 17 — — 5 15 20 1954 - 1 9 3 13 1 - 9 13 23 Total 3 10 78 41 132 15 6 76 144 241 During these ten years more children under the age of 15 years met accidental deaths than died of diphtheria, scarlet fever, measles, whooping cough and poliomyelitis combined. Prevention of accidents is the responsibility of every individual citizen. Care and attention in the home, in the factory and on the roads by everyone is necessary if the tragic results of accidents are to be reduced. Infant Mortality.—During 1954 there were 31 deaths of children under the age of 1 year. This represents an infant mortality rate per 1,000 live births of 26.1 as compared with 25.5 for England and Wales. The causes of infant deaths are shown in Table III. Table III. In the following table, in the local infant mortality rate over 5 year periods from 1898 is shown:— No. of live births No. of deaths under 1 year Infant Mortality Rate 1898-1902 4,369 698 160 1903-1907 5,264 665 126 1908-1912 5,383 590 110 1913-1917 4,661 461 99 1918-1922 4,326 327 76 1923-1927 4,333 271 63 1928-1932 6,055 318 53 1933-1937 7,121 313 44 1938-1942 6,912 393 57 1943-1947 8,210 345 42 1948-1952 6,680 146 22 1953 1,268 23 18 1954 1,185 31 26 Figure I shows the trend in the Borough during the last 25 years of the infant mortality rate (deaths under 1 year per 1,000 live births) the death rate at ages under 1 week per 1,000 live births and the stillbirth rate (stillbirths per 1,000 total births). It will be seen that the fall in the infant mortality rate has been brought about mainly by the saving of infant life at ages over one week. This is illustrated again below :— % of total infant deaths 1930-34 1950-54 at age under 1 week 31.7 59.7 at age under 1 month 47.0 69.0 at ages 1 to 11 months 53.0 31.0 Now 60 per cent, of infant deaths occur before the babies are one week old. The causes of infant mortality may be considered in two broad groups:—(a) infections (pneumonia, gastro-enteritis, tuberculosis, etc.) and nutritional disorders (marasmus, rickets, etc.) and (b) other causes of which the chief are prematurity, congenital malformations, birth asphyxia and birth mjuries. The trend of these two groups is shown in Figure II. I he decline is greater in deaths due to infection. Improved infant feeding and hygienic methods should remove nutritional disorders and prevent gastro-enteritis. A break-down in these methods, such as occurred in 1942, shows what a danger gastro-enteritis can be and point the need for continued care. he main problem today is infections of the respiratory system. Improved housing and reduction of overcrowding will help,' but improved mothercraft and a greater appreciation of the need to shield young babies from infection are more likely to be effective. 9 The underlying causes of prematurity, congenital malformations, etc., seem to be closely associated with those of stillbirths and the trend of the stillbirth rate (Figure I) is like that of the neo-natal mortality rate. " In many cases it is merely a matter of chance whether the foetus dies within the womb, in the birth passages or immediately following birth." If the infant mortality, neo-natal mortality and stillbirth rates are studied in the social groups into which the population is divided by the RegistrarGeneral, it is found that all these rates are lowest in social class 1, professional, managerial, etc.) and highest in social ciass V (unskilled workers) and these differences have remained unchanged over the last 30 years. This shows that there are factors other than nutrition, housing, income, etc., and research is tending to concentrate on"the mother and child during pregnancy and labour. If the loss of life from stillbirths and early death of babies is to be reduced, local health authorities, general practitioners and hospitals have a part to play in trying to improve mothercraft, ante-natal carc and the management of birth. Maternal Mortality.—No death occurred due to causes associated with pregnancy and childbirth. Maternal deaths are usually divided into those due to septic infection and those due to diseases and other conditions associated with pregnancy and labour, and the local trend of deaths from these two causes is shown below :— Maternal deaths per 1,000 total (live and still) births. Sepsis Other Causes Total 1930-34 2.6 1.7 4.4 1935-39 1.0 2.1 3.1 1940-44 0.7 1.2 1.9 1945-19 0.2 1.2 1.4 1950 — 0.8 0.8 1951 — - - 1952 — - - 1953 — 0.8 0.8 1954 — - - Here, as throughout the country, advances in the prevention and treatment of septic infections can be measured by the considerable reduction in deaths from septic abortion, puerperal fever, etc. Fluctuations in the number of maternal deaths due to causes other than sepsis, serve to remind us of the need for improving ante-natal and obstetric care. INFECTIOUS DISEASE Notification to the Medical Officer of Health is the essential preliminary to the control of infectious disease. The diseases required by statute to be notified are:—smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus fever, typhoid fever, paratyphoid fever, relapsing fever, plague, poliomyelitis, tuberculosis, malaria, dysentery, puerperal pyrexia, ophthalmia neonatorum, acute primary pneumonia, acute influenzal pneumonia, whooping cough, measles, acute encephalitis, meningococcal infection, and food poisoning. It is known that all cases are not notified, but there are no grounds for suspecting that the level of notification varies to any great extent from year to year. Persons travelling overseas may require to produce evidence of recent vaccination against smallpox or inoculation against yellow fever, cholera and typhoid fever. Such certificates require to be endorsed by the Medical Officer of Health, and during the year 323 were so endorsed. Incidence of Notifiable Disease.—The number of cases notified during the last ten years are shown below:— 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 Smallpox - - - - - - - - — — Scarlet Fever 124 67 62 159 138 92 67 161 161 71 Diphtheria 24 16 3 2 — 1 -— — — Erysipelas 16 19 19 21 26 12 12 19 16 17 Pneumonia 25 47 56 41 52 64 59 58 78 34 Meningococcal Infection 11 13 8 2 2 — 5 5 1 4 Epidemic encephalitis 1 — — — — — — — — Post-infective encephalitis - - - - - - 1 - — 1 Poliomyelitis and polioencephalitis 7 1 43 29 14 9 4 3 11 — Typhoid fever — 1 1 — — 3 1 — — - Paratyphoid fever — — 3 — 6 1 7 — I Dysentery 28 6 — 5 2 6 77 28 13 9 Food Poisoning - - - - - 5 6 53 53 48 Tuberculosis— Pulmonary 128 200 160 147 208 163 163 148 123 51 Tuberculosis— „ Non-pulmonary 29 17 20 21 11 19 22 20 18 / Ophthalmia neonatorum 3 2 — — — 1 1 2 13 - Puerperal pyrexia 45 54 60 23 16 8 13 53 67 33 Measles 1,109 170 840 571 523 881 790 1,027 602 38 Whooping Cough 110 170 142 227 173 206 222 86 291 35 Malaria 2 1 — — 1 1 — 1 3 2 Undulant fever - - - - - 1 — 1 — - The age distribution of notifiable disease during 1954 is shown in Table V. 10 Smallpox.—No case of smallpox occurred in the Borough during 1954. Persons arriving in the Borough from parts of the world where smallpox is prevalent, are kept under observation till any chance of their developing the disease is over. Freedom from smallpox has resulted in a neglect of infant vaccination. According to the returns, 589 children under the age of one year were vaccinated in 1954. Modern travel is such that the risk of importing smallpox is ever present. Scarlet Fever.—The continuing mildness of this disease is tending to make parents, and possibly doctors, careless about home isolation and other measures to prevent the spread of infection. Of the 71 cases which occurred during the year, 15 were admitted to hospital. No death from this disease has occurred in the Borough since 1937. Diphtheria.—No explanation other than immunisation can be offered to account for the great change (shown in Table VI) that has come about in regard to diphtheria. This change can be maintained only if a sufficiently high proportion of the child population continue to be protected by immunisation. Unfortunately, the removal of the fear of diphtheria has resulted in a fall in the proportion of new babies being immunised. The number of children under the age of one year protected against diphtheria in 1954 was 610; fewer than in 1953. Parents of young children must not be lulled into a false sense of security because diphtheria no longer occurs among the children of friends and neighbours. Erysipelas.—The number of notifications, 17, is an increase of one compared with the previous year, but no death was due to this disease. Pneumonia.—Notifications of pneumonia were 34, as compared with 78 in 1953. The death rate from pneumonia per 1,000 population was 0.3, compared with 0.5 in 1952 and 1953. Of the total pneumonia deaths, 72 per cent, occurred at age 65 and over. Meningococcal Infection.—Four cases of this disease, formerlv classified as cerebrospinal fever, were notified. All were admitted to hospital and recovered. Epidemic Encephalitis.—No notification was received during the year. Post-Infective Encephalitis.—Encephalitis is known to occur as a complication of other infectious diseases and one such case was notified during 1954. The infectious disease in this case was mumps. Poliomyelitis and Polioencephalitis.—For the first time since 1943 no case was notified. The disease was fairly prevalent in the country and no explanation other than chance can be offered for its absence from the Borough. Typhoid Fever.—No case of typhoid fever was notified during the year. Paratyphoid Fever.—During the year one case of paratyphoid fever was notified. The illness occurred while the child was in a London hospital and the source of the infection was not traced. Dysentery.—This disease shows great variations in prevalence from year to year and from place to place. During the year, 9 cases were notified, and of these two were nurses in a local hospital. I lie ages of the cases ranged from 3 years to 69 years; one was under five years of age and two were of school age. No connection was traced between any of the local households concerned. 1 he infection in all cases was of the Sonne type and the illness was mild in practically every case. The mildness of the illness is such that medical advice is not always sought, and unless the disease is kept constantly in mind, cases are likely to be missed. In all cases of diarrhoea in children and on the least suspicion in adults, a specimen of faces should be sent for bacteriological investigation. Only by such vigilance will this disease be kept under some degree of control. Tuberculosis.—During the year, 81 notifications of pulmonary tuberculosis, and 7 notifications of non-pulmonarv tuberculosis were received. This is the lowest tuberculosis notification rate recorded in the Borough. In recent years the notification rate has remained at much the same level, though the death rate from tuberculosis has fallen and this suggested that there was still some reservoir of infection which was not being treated. Persons continue to be certified as dying from tuberculosis who have not been notified during life, but it is hoped that with the improved facilities for diagnosis and treatment now available, any reluctance to seek investigation and treatment will disappear. Early diagnosis and treatment are essential to reduce the risks of the spread of infection. I ne trend of the Borough death rate from tuberculosis is shown below :— Tuberculosis Death Rate per 100,000 population pulmonary Non-pulmonary Total 1930-34 67.5 11.5 78.9 1935-39 52.3 8.2 60.4 1940-44 55.8 7.4 63.2 1945-49 39.1 6.7 45.8 1950 33.6 0.9 34.5 1951 24.4 0.9 25.4 1952 15.1 2.8 17.9 1953 9.5 0.0 9.5 1954 11.4 0.9 12.3 the decline in the death rate from tuberculosis in this country started about the middle of last century, and it is difficult to assess the many factors which may have played their part. 11 Ophthalmia Neonatorum.—For the first time since the disease was made notifiable, no case was reported in the Borough. It is a tribute to preventive medicine that this infection of the eyes of babies which was once a common cause of blindness has now been brought under control. It is unlikely that the disease will disappear completely, but when it does occur, modern treatment should prevent any damage to sight. Puerperal Pyrexia.—During the year, 33 cases were notified as compared with 67 cases in 1953, A change in the definition of puerperal pyrexia was introduced by the Puerperal Pyrexia Regulations 1951. No woman died from puerperal or post-abortion sepsis. Measles.—Only 38 cases were notified during 'the year, but if the disease follows its usual rhythm, many more cases will occur in 1955. No death from measles was recorded. Whooping Cough.—The; notifications of whooping cough, 35, were less than in 1953. Facilities for immunisation against this disease are available. The condition is most fatal in young babies, and protection should be provided before the child is six months old. There is evidence that, with the improvement in the vaccine, the protection, if not complete, does mitigate the severity of the attack. According to the records, 515 children under the age of one year received inoculations against whooping cough during the year. Malaria.—Two cases of malaria were notified during the year and investigations showed that they were recurrences of infections originally contracted in Korea and West Africa. Influenza.—This disease was not prevalent during the year. It caused 2 deaths as compared with 26 in 1953, 4 in 1952, 33 in 1951 and 6 in 1950. Mumps, Chicken Pox, German Measles.—These diseases are not notifiable, but cases are brought to the notice of the Department through schools, health visitors, etc. During the year, the following cases were recorded:—mumps, 372; chicken pox, 369; and German measles, 14. The latter disease has received considerable attention recently, because its occurrence in a mother during the early months of pregnancy may result in the child being born with a congenital defect. Fever Hospitals.—The Borough is served by the South Middlesex Infectious Diseases Hospital, but on occasion, accommodation in other fever hospitals of the North West Metropolitan Regional Hospital Board is used. During the year, 79 patients from the Borough were admitted to these hospitals. Close contact is maintained between the hospitals and the Health Department, so that any necessary action can be taken. Disinfection.—The disinfection of bedding, etc., is done at the South Middlesex Infectious Diseases Hospital, while the disinfection of homes is carried out by the disinfectors on the Health Department staff. In 1946, after considering a report on the subject, the Council decided to stop terminal disinfection of rooms and bedding "except in cases of smallpox or where the Medical Officer of Health considers such disinfection to be advisable". During the year, four rooms were disinfected and 11 lots of bedding destroyed. Laboratory.—Certain routine bacteriological work is done in the laboratory at the Health Department. When more detailed investigation is required, specimens are sent to the National Public Health Laboratory Service. The number of specimens examined during 1954 was 305. The majority of these specimens were taken during the investigation of dysentery and food poisoning. Food Poisoning.—Section 17 (1) of the Food and Drugs Act, 1938, states : " If a registered medical practitioner becomes aware, or suspects that a patient whom he is attending within the district of any local authority is suffering from food poisoning, he shall forthwith send to the Medical Officer of Health of that district a certificate stating :— (a) the name, age and sex of the patient and the address of the premises where the patient is; and (b) particulars of the food poisoning from which he is, or is suspected to be, suffering. If the Health Department is to have a real chance of tracing the origin and source of food poisoning, they should be on the job as soon as food poisoning is suspected. Delay in notification continues to hamper the investigation of cases. The possibility of food poisoning should be kept in mind in all cases of "gastric flu" and unexplained vomiting and diarrhoea. During 1954, notifications of the occurence of food poisoning m 48 persons were received, and during the course of our investigations and from other sources, a further 25 cases were discovered. A considerable amount of time and effort was devoted to investigation o these incidents, and a summary of the findings is given below :— Cases of Food Poisoning. 1st 2nd 3rd 4th Ouarter Ouarter Quarter Ouarter To'al 5 (2) 22 (20) '12 (9) 34 (17) 73 (48) Outbreaks due to identified agents Total outbreaks Total cases 3 (2) 9 (5) Outbreaks of undiscovered cause Total outbreaks Total cases 5 (4) 50 (29) Single cases Agent identified unknown cause Total cases 1 (1) 13 (13) 14 (14) ( ) = notified under Section 17 of the Food and Drugs Act, 1938. 12 Of the outbreaks involving more than one person, the suspected food was consumed at home in 6 cases and in works canteens in 2 cases. The investigation of several of the single cases raised doubts about the condition being truly due to food poisoning. In September, some of the local medical practitioners drew the attention of the Department to the occurrence of many cases of vomiting and diarrhoea in their practices and raised the suspicion of an outbreak of food poisoning. Enquiries at the schools in the affected area revealed that many children had been away for 1—3 days with symptoms of which vomiting was the most prominent. On visiting the homes of these children, it was found in many cases that other members of the family had been affected and histories of one person after another in the household falling a victim were, quite frequent. The onset was sudden and the main symptoms were nausea and vomiting with occasional diarrhoea. In some cases a rise of temperature was recorded, but this was not general. The symptoms generally cleared up in 24 hours and in many cases no medical attention had been sought. In others the attack cleared up more slowly and as many as 7 days passed before full recovery. In no case was the development of jaundice or other complication recorded. The outbreak started fairly abruptly and after reaching a peak, slowly abated to finally clear at the end of October. All specimens sent for bacteriological and virus investigation gave negative results. There was no evidence of any common factor, such as school, place of employment, water, milk or other food. For some years outbreaks of sudden and unexplained vomiting and diarrhoea have occurred in this country and in United States of America. These illnesses have been called " epidemic winter vomiting " and " epidemic gastro-enteritis " and recent work in America seems to indicate that the condition is a virus infection. It is probable that this local outbreak was of the same nature. HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES North-West Metropolitan Regional Hospital Board.—Two general hospitals (West Middlesex, 1,150 beds and Hounslow, 81 beds) and one fever hospital (South Middlesex, 140 beds) are situate in the Borough. Part of the accommodation in the fever hospital is used for other cases. The West Middlesex and South Middlesex Hospitals are controlled by the South West Middlesex Hospital Management Committee, while Hounslow Hospital and the Chest Clinic are the responsibility of the Staines Group Hospital Management Committee. The Regional Hospital Board provides the specialist services for the hospitals and for domiciliary consultations. Middlesex County Council—Health Department.—The County Council is the Local Health Authority under the National Health Service Act, 1946. The following services are provided in the Borough:— (a) Ante-natal and post-natal clinics 92 Bath Road, Hounslow Monday and Wednesday mornings. Thursday afternoon. Busch Corner, Isleworth Tuesday afternoon. Heston Village Hall Thursday afternoon. (b) Infant welfare clinics 92 Bath Road, Hounslow Tuesday, Wednesday, Thursday and Friday afternoons. Busch Corner, Isleworth Monday and Wednesday afternoons. Heston Village Hall Monday and Tuesday afternoons. Friday morning. Cranford Memorial Hall Monday and Friday afternoons. (c) Immunisation and vaccination clinics 92 Bath Road, Hounslow Wednesday afternoon, Thursday morning. Busch Corner, Isleworth Tuesday (fortnightly) afternoon. Heston Village Hall Tuesday (fortnightly) morning. (d) Artificial Sunlight clinics (winter months) 92 Bath Road, Hounslow Tuesday and Friday afternoons. Busch Corner, Isleworth Tuesday and Friday afternoons. (e) Dental clinics Busch Comer,' Houslow Monday to Friday daily and Saturday mornings. (f) Day nurseries Approved accommodation Nantly House, Lampton Road 54 children. Acton Lodge, Brentford End 35 children. 1 hese day nurseries admit children aged 0-5 years and a charge is made for the care of the children. (g) Midwifery Service. Certified midwives are employed for attendance as midwives or maternity nurses at domiciliary confinements. Gas and air analgesia is available. Maternity outfits are supplied free for home confinements. (h) Home Nursing. Male and female nurses are employed as " district" nurses. Where nursing equipment is required for use in the home, arrangements have been made for this to be supplied on loan through the British Red Cross Society at 78 Lampton Road, Hounslow. 13 (i) Health Visitors. Health Visitors who also act as School Nurses are employed in clinics and home visiting. Their work is largely educational and social, and is defined in the Act as " giving advice as to the care of young children, persons suffering from illness, and expectant and nursing mothers, and as to the measures necessary to prevent the spread of infection." (/) Domestic Helps. Home helps are employed to provide domestic help for households " where such help is required owing to the presence of any person who is ill, lying-in, an expectant mother, mentally defective, aged, or a child not over compulsory school age." A charge is made for this service and in assessing this, regard is had to the means of the persons concerned, (k) Prevention of Illness, Care and After-care. The care and after-care of tuberculosis persons is dealt with by the Welfare Officer at the Chest Clinic. Among other things, the County Council scheme provides for the admission of persons, not in need of medical or nursing care, to recuperative holiday homes and for this a charge is made according to the person's circumstances. (/) Ambulance Service. Provision is made for the conveyance of sick, accident and emergency cases, and the service is organised in association with the Fire Service. The accident and emergency service is stationed at the Fire Station, Isleworth, and the sick removal service at West Middlesex Hospital. (m) Mental Health. This service provides for the ascertainment of cases of mental ill-health and mental deficiency, the statutory supervision and guardianship of mental defectives living in the community, and the provision of after-care for persons who have undergone treatment for mental illness. The office of the Mental Welfare (Duly Authorised) Officer for the Borough is at County Offices, Great West Road, Brentford. Middlesex County Council—Education Department.—The School Health Service is staffed by the County Health Department and provides the following services :— (a) routine medical inspection of pupils (b) cleanliness surveys of pupils (c) dental inspection of pupils (d) ascertainment of handicapped pupils in need of special education (e) treatment clinics as under :— (i) minor ailments 92 Bath Road, Hounslow daily—mornings Busch Corner, Isleworth daily—mornings Heston Village Hall daily—mornings Cranford Junior School daily—mornings (ii) Medical consultation 92 Bath Road, Hounslow Tuesday and Friday mornings Busch Corner, Isleworth Monday and Wednesday mornings Heston Village Hall Thursday morning Cranford Junior School Tuesday (fortnightly)—morning (iii) eye clinic 92 Bath Road, Hounslow Monday and Wednesday afternoons Monday morning Busch Corner, Isleworth Thursday morning (iv) allergy clinic 92 Bath Road, Hounslow Monday afternoons (v) orthopaedic clinic 92 Bath Road, Hounslow 4th Monday morning (vi) physiotherapy 92 Bath Road, Hounslow Wednesday and Thursday afternoons. Thursday morning (vii) dental clinic artificial sunlight clinic ) (see under Health Department) immunisation clinic J v r (viii) child guidance clinic Old Town School, Hounslow, by appointment (ix) speech therapy by appointment Middlesex County Council—Welfare Department.—This service is concerned with the welfare of aged, physically and mentally infirm, blind and partially sighted, deaf and dumb, epilep i ind crippled persons and the provision of temporary accommodation for persons in urgent need thereo . The address of the Welfare Officer for the Borough is County Offices, Great West Road, Brenttor 14 Middlesex County Council—Children's Department.— This Department deals with children taken into or committed to the care of the County Council, supervision of foster children, adoption, child neglect, etc. The Children's Officer for the Borough works from County Offices, Great West Road, Brentford. Middlesex Executive Council.—This body is responsible for the provision under the National Health Service Act of the general practitioner, dental (other than Local Health Authority provision for expectant and nursing mothers, young children and school children), pharmaceutical and supplementary ophthalmic services. The headquarters of the Council is at North West House, 119 Marylebone Road, N.W.I. SANITARY CIRCUMSTANCES Physical Characteristics.—The Borough has an area of 7,218 acres and lies in the Thames Valley on the north bank of the river. From the river, the land rises slowly until at North Hyde it is about 100 feet above sea level. The subsoil consists of " drift gravels " and lying on them in places are patches of clay. The following open spaces are laid out and controlled by the Borough Council : — Park Farm and Avenue House, Cranford 40.29 acres Heston Fair Ground 9.38 „ Church Meadow, Bath Road 9.20 ,, Children's Playground, Sutton Lane 0.60 „ Kingsley Road Playing Field 0.95 ,, Greenhams Land, London Road 14.75 ,, St. John's Gardens, Isleworth 5.73 Riverside Walk, Isleworth 0.75 ,, Children's Playground, Northcote Avenue 0.85 ,, Playground, London Road 1.84 ,, Bowling Green, Jersey Gardens 0.59 ,, Isleworth Promenade 1.0 „ Heston Park 14.29 ,, Lampton Park 24.20 ,, Beaversfield Park 9.77 ,, Inwood Park 10.25 Redlees Park 16.47 ,, Jersey Gardens 7.87 ,, Football Ground, Denbigh Road 3.70 ,, Midsummer Children's Playground 1.52 „ Water Supply.—The water supply of the Borough is derived almost wholly from the Metropolitan Water Board. A small portion of the Cranford area is supplied by the South-West Suburban Water Company. There are in the Borough 45 shallow and 3 artesian wells serving 42 premises and of these 4 houses and 3 business premises are without an alternative supply. The following work in connection with water supplies was carried out during the year :— Supplies provided or reinstated 21 Cisterns, cleansed, repaired, etc. Draw-off taps connected direct to main Service pipes or taps repaired 26 Cases where mains supplies substituted for well supply 3 Drainage and Sewerage.—The drainage and sewerage of almost the whole of the Borough is arranged on the separate system and forms part of the West Middlesex Sewage Scheme. A few houses on the outskirts of the Borough drain to cesspools. The following work was carried out during 1954 :— Drains exposed for examination 102 Drains unstopped, repaired, etc 301 Waste pipes repaired, trapped, etc. 28 Soil pipes repaired, etc. 3 Ventilating shafts repaired, etc 5 Fresh air inlets repaired, etc. 12 Rainwater pipes disconnected from drains 4 Gully traps inserted or repaired 29 Disconnecting traps inserted or repaired 2 Disconnecting and inspection chambers provided 5 Disconnecting and inspection chambers repaired, etc. 62 Drains constructed or repaired 31 Total length (ft.) of drain pipes laid— (a) 4" 202 (b) 6" 4 Drain tests applied 36 Other works executed 10 Cesspools emptied or repaired 4 Cesspools abolished 1 15 While the Borough is responsible for the local sewerage of its own district, the duty of the disposal of sewage is the responsibility of Middlesex County Council. The West Middlesex Main Drainage Undertaking has been in full operation since 1936. It serves an area, including the Borough, of 162 square miles, with a population (1951 census) of 1,340,000. There are 70 miles of main sewers, varying in diameter from 2 feet to 13 feet. The sewage flow at the Mogden Works averages 85 million gallons per day, though this mav reach as high as 250 million gallons per day in wet weather. Rivers and Streams.—No complaint of pollution was made to the Health Department during 1954. A watch is kept on streams for evidence of breeding of mosquitoes. The County Council has started systematic sampling of the River Brent at fixed points at monthly intervals. Samples are also taken of surface waters which are suspected of causing pollution. The Department co-operates in the tracing of possible sources of pollution and in seeking a remedy where pollution is proved. Closet Accommodation.—The closet accommodation of the Borough consists almost wholly of water closets connected to the sewers. A few water closets drain to cesspools, and several houses on the outskirts of the Borough have pail or chemical closets. The following works were carried out during the year : — Water closets constructed or rebuilt 7 Water closets provided in substitution for dry receptacles, etc. 2 Water closets where walls cleansed 9 Water closets fitted with new flushing apparatus 20 New pans or pedestals provided 24 Water closets repaired or improved 51 Water closets blockages unstopped 7 Other closets provided or repaired — Water closets connected to sewer and cesspools abolished — Urinals constructed, rebuilt or repaired 3 Public Cleansing.—The Borough Engineer has supplied the following notes on public cleansing : — (a) Refuse Collection and Disposal. The collection and disposal of refuse during the past year has followed the same pattern as formerly. Although the continued labour shortage has strained the organisation severely, it has been possible by a flexible disposal of the forces available to maintain a weekly collection throughout 1954. Credit in helping to make this possible must go in large measure to the regular collectors for the vigour they have consistently displayed, particularly at times when absence from sickness or other causes has reduced numbers and made it necessary for temporary staff unaccustomed to this class of work to be employed. The quantity of refuse collected from houses in 1954 approximates 31,200 tons. This was collected from 30,554 premises and contained in 35,090 dustbins. Contrary to the practice adopted bv some authorities, householders are not required to place their bins at the kerb, the bins being carried bv the collectors from the rear of the premises and returned after1 having been emptied. The normal strength of the service comprises 44 collectors working in seven gangs with 16 vehicles. Trade refuse when in large quantities is collected independently. While most householders are co-operative, they could render further useful assistance by bearing in mind a few simple points and acting accordingly. Dry refuse only should be placed in bins. Damp refuse should be burned, or, if this is not possible, it should be dried or well wrapped in paper before placing in the bin. Not every house has the gate unlocked when the collector calls, and apart from the man's wasted time, irritation is frequently caused by the resulting non-collection. I here are occasions also when, for some unavoidable reason, the collection cannot be made on the usual day, and householders become annoyed if their bins overflow as a result. The normal size bin, however, if used only for dry refuse from a single household, will be found to be adequate for more than one weeks supply. Above all, householders are strongly advised to purchase a good quality bin. Bins are subjected to heavy usage, and it is more economical in the long run to obtain one that will stand up to this. There is a standard specification for dustbins drawn up by the British Standards Institution, and purchasers would do well to satisfy themselves that their bins are of that quality. Salvage continues to be collected at the same time as refuse and is segregated before sale, ihe collection of kitchen waste was discontinued in January, 1954. The returns for the past five years are as follows :— 1950 1951 1952 1953 1954 Paper (tons) 1,331 1,111 1.023 986 1,000 Scrap metal (tons) 80 78 89 84 90 Textiles (tons) 75 57 50 41 27 Bones (tons) 1 — — — Bottles, jars (tons) 36 63 10 11 17 Cullet (tons) 6 4 7 — 3 Kitchen Waste (tons) 1,013 1,032 929 822 9 Total Income £14,426 £20,902 £15,614 £11,440 £8,705 Refuse is disposed of by controlled tipping on land after gravel has been extracted therefrom. In this way, many acres of old gravel workings are being brought into a condition that will enable t en to be laid out as playing fields or used for other suitable purposes. 16 (b) Street Cleansing. Street cleansing is carried out on the " beat " system, each orderly being responsible for one beat. The length of beat varies, the average being two miles. Owing to the labour shortage the Council are contemplating the introduction of mechanical sweeping to reinforce the street orderly service. (c) Gully Emptying. All street gullies are emptied mechanically at a frequency programmed at four times a year. It has been the practice in the Borough for many years to require the owners of property to supply new dustbins when necessary. Informal notices continue to be served on the owner, but if this does not secure the provision of a new dustbin, the matter has to be considered carefully by the Health Committee to decide, as provided in the Act, whether formal notice shall be served on the owner or the occupier. Any person aggrieved by such formal notice may appeal to a court of summary jurisdiction. During the year, one owner appealed against a formal notice and the Court ruled that the dustbin should be provided by the tenant. Through action by the Health Department, 78 new dustbins were provided during the year. Sanitary Inspection of the Borough.—In addition to the work recorded in other paragraphs of this Report, the Sanitary Inspectors continued their general duties of investigating complaints, abating nuisances and dealing with contraventions of the Public Health Act. Originally, the sanitary inspector was expected to exercise legal powers to improve environmental conditions. The legal powers and duties remain, but today these officers are increasingly regarded more as advisors than as policemen. To give good advice and to try to see that it is followed requires more tact, tenacity and time than to demand that the law be obeyed—and often produces more lasting results. Not all complaints brought to the Health Department deal with matters on which the Department is empowered to take action, and in such cases complainants are advised, as far as is known, how and where the matter may receive attention. Some particulars of the work done are shown below :— Inspections following complaint 1,150 Number of premises at which nuisances, etc., were located 825 Number of premises where defects were remedied (a) by owners or occupiers 746 (b) by Council in default 5 (c) public sewers repaired by Council 19 Informal notices issued 497 Written reminders issued 543 Statutory notices served 115 Total number of inspections and re-inspections 23,041 Inspections of piggeries 40 Inspections of stables 31 Inspections of urinals 182 Sinks provided or repaired 12 Roofs repaired 157 Gutters repaired or renewed 140 Brickwork, sills, etc., repaired or renewed 226 Premises provided with damp-proof courses 10 Sites covered with impervious material 4 Yards and forecourts paved or drained 17 External painting 32 Rooms stripped, cleansed and redecorated 317 Floors, walls and ceilings repaired or renewed 511 Rooms in which ventilation provided or improved 15 Rooms in which lighting provided or improved 2 Windows repaired or renewed 312 Doors and other woodwork repaired or renewed 77 Staircases replaced or repaired 10 Lighting to staircase provided or improved — Handrails or balusters repaired or renewed 5 Grates provided or repaired 106 Instances where ventilation under floor provided or improved 3 Larders provided or repaired 8 Domestic cleansing enforced 5 Improper keeping of animals abated 7 Offensive accumulations removed 36 Pigsties provided, repaired, cleansed, etc. 3 Other repairs carried out or nuisances abated 94 Visits re infectious diseases, etc. 383 Complaints continue to be received of nuisance caused by pigeons. Apart from those particularly anected, the public tends to be on the side of the pigeons, but the damage and nuisance caused by them is considerable. Apart from the fouling of premises, they love cement and mortar, and thus open up brickwork for frost and rain to attack. The public should not encourage pigeons by making food available to them. Throughout the Borough, unfenced land, rear passages, roadside ditches and ponds are used as dumps for garden refuse, rubble, tins, disused water tanks, broken furniture, defective household utensils, worn motor tyres, etc., and these accumulations are most unsightly. They are seldom "prejudicial to health or a nuisance " within the meaning of the Public Health Act. The Department does what it can to deal with these eyesores, but rarely can the offenders be traced. " Keep the Borough tidy " should be practised by all. 17 The fouling of footpaths by dogs is much too prevalent. Training of dogs would do much to prevent this and there is no excuse for permitting dogs on lead to foul footpaths. A local bye-law states, " No person being in charge of a dog in any street or public place, and having the dog on a lead, shall allow or permit such dog to deposit its excrement upon the public footway " and for such offence there is a penalty not exceeding £5. Here the difficulty is to secure the name and address of the offender and of witnesses willing to testify. Exchange of Articles for Rags, etc.—Under the Public Health Act, 1936, it is an offence for any person who collects or deals in rags, etc., to sell or deliver, whether gratuitously or not, any article whatsoever to a child under the age of 14 years in exchange for rags, etc. The Police notify the Council of any such contraventions coming to their notice. During the year, 3 persons were prosecuted and fines of £3, 10/- and 10/- were imposed. Smoke Abatement.—The emission of smoke, grit and ash from a factory chimney may constitute a nuisance within the meaning of the Public Health Acts. During the year the Sanitary Inspectors made 234 smoke observations and paid many visits to premises in regard to which complaints of smoke nuisance had been received. Four smoke nuisances were proved at two premises and they were due to mechanical defect, and unsuitable material being consumed. With the co-operation of the Education Department, a course on boiler house practice was arranged at Spring Grove Polytechnic, but the attendance was disappointing. Complaints about the quality of fuel are still too frequent, while defects in plant and inadequate training of stokers receive too little attention. The Council co-operates with the Department of Scientific and Industrial Research by measuring atmospheric pollution in the Borough. Two sets of apparatus are in use; one on the roof of the Health Department in Bath Road, Hounslow, and the other on the roof of Heath House, London Road, Isleworth. The deposit gauge is designed to collect solid and liquid material in the atmosphere and the analysis gives the amount of grit, tarry matter, sulphate and other chemicals. The extent to which finer particles and gasses are collected depends on atmospheric conditions. For estimation of sulphur dioxide, a cylinder, coated with lead peroxide, is exposed and the quantity of sulphur dioxide is estimated from the quantity of sulphate formed. The total atmospheric pollution is certainly greater than is recorded by these instruments, but the records give a good indication of the extent of such pollution and over a period of years form a useful basis for studv. and over a period of years form a useful basis for study. The detailed monthly analyses are forwarded for record and studv to the Central Department, but the main features are recorded below :— Health Department Heath House Rainfall (inches) Deposit (tons per sq. mile) Sulphur (Mgms. So3 per day per 100 sq. cm.) Rainfall (inches) Deposit (tons per sq. mile) Sulphur (Mgms. So3 per day per 100 sq. cm.) January 0.95 9.72 2.27 0.99 9.96 2.28 February 1.81 12.26 2.19 1.93 10.64 2.19 March 2.20 11.74 1.96 2.29 11.15 2.18 April 0.35 4.86 0.66 0.35 2.80 0.86 May 1.97 10.92 0.68 2.01 12.60 0.67 Tune 3.69 4.00 0.43 3.82 4.73 0.50 July 2.72 4.08 0.31 2.64 3.31 0.38 August 3.31 3.12 0.25 3.59 3.51 0.25 September 1.85 6.47 0.36 1.81 7.50 0.40 October 2.32 7.36 0.65 2.17 8.38 0.55 November 3.39 10.30 0.91 3.39 9.53 0.96 December 1.81 8.39 0.69 1.89 7.80 0.77 Average 2.20 7.77 0.95 2.24 7.66 0.99 Average 1952 and 1953 1.86 9.93 0.97 1.88 10.36 1.03 In general, atmospheric pollution was less in 1954 than in the previous two vears. (See Figures III and IV.) The heavy toll of deaths arising from the " smog " in Greater London in December, 1952, stimulated interest in smoke abatement to a greater extent than the 30 years of propaganda on the same subject. The Government appointed a Committee "to examine the nature, causes and effects o air pollution and the efficacy of present preventive measures ; to consider what further preventive measures are practicable; and to make recommendations." The Committee issued an interim report in November 1953, and a final report (Cmd. 9322) in November, 1954. In regard to the economic cost of atmospheric pollution the Committee state :— " The economic effects of pollution can be considered under two heads; direct costs and loss of efficiency. 18 FIGURE TTT 19 F / CURE IT 20 The direct costs include laundry and domestic cleaning; the cleaning, painting and repair of buildings; the corrosion of metals, which entails the cost not only of replacement, but also of providing protective coverings, etc.; damage to goods; additional lighting and extra hospital and medical services, etc. The loss of efficiency includes, for example, the effects on agriculture of damage to soil, crops and animals, interference with transport and reduced human efficiency due to illness. We have made enquiries of many different sources about the costs falling under each of these heads. After examining all the evidence we have been able to obtain, we feel justified in stating that air pollution is at present costing the nation £250,000,000 a year in terms only of losses that can be given a monetary value. This does not include the value of the fuel that is lost through incomplete combustion, one of the main causes of smoke. This probably amounts to between £25,000,000 and £50,000,000 a year and represents a waste of coal which the nation cannot afford. Nor, as we have said, do they include those costs that cannot be measured in terms of money, though they may be immense, for instance, the loss of happiness and health." The Committee submitted recommendations, some entailing legislation and others to be brought into operation through other channels. The Committee recommends that except for certain specified processes, the responsibility for enforcing the law for the prevention of smoke and grit should be placed as a statutory duty on the local authorities. Legislation to implement the recommendations of the Committee is awaited, but attention is drawn to the following extract from the Report :— "We wish to state our emphatic belief that air pollution on the scale with which we are familiar in this country today is a social and economic evil which should no longer be tolerated, and that it needs to be combated with the same conviction and energy as were applied one hundred years ago in securing pure water. We are convinced that given the will it can be prevented. To do this will require a national effort and will entail costs and sacrifices; the recommendations made in this Report will involve expenditure by the Government, local authorities, industry and householders alike, but we are confident that our proposals, if carried out, will secure happier and more healthy living conditions for millions of people, and that on all counts the cost of the cure will be far less than the national loss in allowing the evil to continue." Tents, Vans and Caravans.— There are five sites in the Borough which have been used as caravan sites for many years. Some are occupied wholly or in part by persons who use caravans for business in connection with a travelling circus, fair or stall. During the year, the inspectors made 627 visits of inspection because of the occupation of land by caravans. Trespass by caravans on unfenced land continues. Four applications under the provisions of the Middlesex County Council Acts for permission to place caravans on sites within the Borough were considered; three were approved for a limited period, and the other was refused. Common Lodging Houses.— There is no common lodging house in the Borough. Canal Boats.— The Sanitary Inspectors continue their duties as canal boat inspectors, and made 68 inspections during the year. Factories, Workplaces, etc.— The Factories Act placed on the Council certain duties in regard to (a) outworkers; (b) employment of persons in unwholesome premises; (c) basement bakehouses; {d) provision of sanitary conveniences in all factories, and (e) cleanliness, over-crowding, ventilation and drainage of floors in the case of factories in which mechanical power is not used. A summary of the work done is given below and in Table IX. Inspection of (a) Factories—mechanical power 711 (b) Factories—non-mechanical power 101 (c) Other premises 10 (d) Workplaces 46 (e) Outworkers' premises 179 Defects remedied 23 At the end of the year the number of outworkers registered with the Department was 187. Mosquitoes.— No complaint of the presence of biting mosquitoes was received during the year. Culex molestus, the biting mosquito that caused so much annoyance during 1939-46, appears to have ceased to breed in the district. Householders, gardeners and allotment holders can do much to discourage breeding of mosquitoes by attending to ponds, waterbuts, liquid manure pits, etc. Disinfestation.— The Health Department deals with bug and other infestations in houses and other premises, and for this purpose D.D.T. and other insecticides are used. During the year, 56 rooms in 23 houses were treated, while 39 wasp nests were destroyed, five premises cleared of cockroaches, our cleared of ants, and two of carpet beetles. Treatment of ponds and tanks to prevent the breeding of mosquitoes was carried out as necessary. Noise Nuisance.—In the Middlesex County Council Act a noise nuisance is deemed to exist where any person makes or continues or causes to be made or continued any excessive or unreasonable or unnecessary noise which is injurious or dangerous to health." Further, it is a good defence for the person charged to show "that he has used the best practicable means of preventing or mitigating the nuisance, having regard to the cost and to other relevant circumstances." Most complaints of noise nuisance arise in connection with industrial processes carried on in factories situated close to houses. 21 From the above definition it will be seen that many factors have to be taken into consideration in judging whether or not a noise is a nuisance within the meaning of the Act, though there may be no doubt about the annoyance to residents in the neighbourhood of the factory concerned. During the year, complaints of nuisance due to noise were received in regard to a factory. Day and night observations were made concerning this complaint, and in conjunction with the firm concerned, measures were taken to reduce the noise as far as was practicable. Rats and Mice Destruction, etc.— The Prevention of Damage by Pests Act, 1949, places the responsibility on the Council "to keep their area as far as practicable, free from rats and mice " and occupiers of premises are required to give notice when they have knowledge that rats and mice are present in substantial numbers. It is obligatory on the Council to recover the expenses reasonably incurred in taking steps for the destruction of rats and mice on business premises, but permissive as far as the cost of treating private dwellings is concerned. The Council has decided to make no charge for the treatment of private dwelling-houses unless there is failure on the part of the owner or occupier to co-operate in preventing infestation. The Ministry of Agriculture and Fisheries may make to local authorities a grant equal to one half of the expenditure incurred in the performance of their duties under the Act so far as such expenditure has not been recovered. No notification of the presence of rats or mice in substantial numbers has been received, but by the visits of the Sanitary Inspectors and the Rodent Officer and complaints of " rats coming from next door," no gross infestation should escape attention. The Council employs a Rodent Officer, who is responsible for systematic inspection, planning of treatment, supervising the work of the rodent operatives and checking results. A summary of the work done in recent years is shown below:— 1950 1951 1952 1953 1954 Complaints received 421 607 618 527 533 Block inspections 37 89 51 46 43 Individual inspections 2,574 3,150 4,441 4,192 3,407 Individual re-inspections 316 221 669 778 974 Other visits 402 438 614 654 503 Premises treated— (a) By occupiers 25 19 41 7 18 (b) By Local Authority 882 743 1,075 930 883 Test baiting and where necessary, treatment is carried out to sewers, watercourses, tips, etc. Destruction of part of the rat population by chemical or other poisoning may increase the food supply and improve the chances of survival of the remainder. Eradication requires environmental conditions which hinder survival, i.e., no food and no shelter and occupiers of premises should bear this in mind. Shops Act, 1950, Section 38.— Shops require to be reasonably ventilated, heated and lighted, and there should be suitable and sufficient sanitary and washing facilities for the persons employed therein. In this connection, 45 inspections were made during the year. Nine certificates of exemption re provision of sanitary accommodation were withdrawn during the year because the necessary provision had been made or the circumstances justifying the exemption were no longer operative. Rag Flock and Other Filling Materials Act, 1951.— This Act is designed to ensure that filling materials used in upholstery, etc., comply with prescribed conditions of cleanliness. Premises using filling materials have to be registered and premises where rag flock is manufactured or stored have to be licensed. It is an offence to sell articles containing unclean materials. Certain records have to be kept on registered and licensed premises and authorised officers of a local authority have powers to enter, inspect and take samples. Under this Act, five premises in the Borough have been registered and the Sanitary Inspectors made seven visits of inspection. Swimming Baths.— Three swimming baths are provided by the Council and one private swimming bath was in operation in the Borough. The size and extent of usage of the three municipal baths are shown below :— Hounslow Heston Isleworth Area of bath major 75' x 30' 100'x 48' 100'x 48' minor 50' x 25' — — Capacity of bath (gallons) major 71,000 200,000 200,000 minor 36,000 — — Total number of persons using swimming bath in 1954 115,919 152,084 121,469 Maximum number of persons using swimming bath on any one day 984 1,949 1,160 (31/8/54) (1/9/54) (1/9/54) No. of slipper baths male 15 — 11 female 9 — 11 No. of persons using slipper baths during 1954 male 29,033 - 14,850 female 12,961 — 8,965 The baths waters are treated by continuous filtration and chlorination. At Hounslow and Hes on Baths the breakpoint system of chlorination has been installed. The advantage of this system, w 10, is more expensive than the usual process and requires close and skilled supervision, is the stronger an 22 more rapid bactericidal action, and this is of special importance at times of high bathing load. While baths' staif do everything to maintain a " safe " standard of bath water, the bathers could assist very materially by the observance of strict personal hygiene. During the year, five samples of baths water were taken and all were found to be satisfactory. Verminous Premises and Articles.— No action had to be taken under Sections 83 and 84 of the Public Health Act, 1936. Verminous Persons.— No verminous person was cleansed under the provisions of Section 85 of the Public Health Act, 1936. During the year, 164 children in attendance at schools in the Borough were found to be verminous and because of the failure of parents to take necessary action, 30 of these children had to be cleansed by the School Health Department. Louse infestation is much too prevalent, and is due solely to lack of personal cleanliness. It is not confined to school children and is found in factory and workplace. Only too often school children, after being cleansed, become re-infested at home. The problem of the persistently verminous child or family is a difficult one and is usually not one of uncleanliness alone. It is merely a feature of something more fundamental and only by finding and removing the real cause of this failure of social adaptation can there be a chance of lasting improvement. Pet Animals Act, 1951.— This Act is designed to regulate the sale of pet animals and the main provision is that no person shall keep a pet shop except under the authority of a licence granted in accordance with the provisions of the Act. Under the provisions of this Act, five premises in the Borough have been licensed and 23 visits of inspection were made during the year. INSPECTION AND SUPERVISION OF FOOD Milk.— During the year, 106 inspections were made at dairies and retail purveyors' premises. Under the Milk (Special Designation) Regulations, 39 licences for the sale of " tuberculin tested" milk, 42 for the sale of pasteurised " milk, and 52 for the sale of " sterilised " milk were issued. The Milk (Special Designations) (Specified Areas) Order, 1951, came into operation on 1st October, 1951. This Order defined the County of Middlesex as an area in which the use of a special designation becomes obligatory for the purpose of all sales of milk by retail for human consumption (other than a catering sale). The special designations permitted are " sterilised " pasteurised " and " tuberculin tested." Complaints of milk being supplied in dirty bottles continue to be received. The number is very small in relation to the large issue to the public. The trade provides machinery and plant which is adequate to cleanse milk bottles which have not been misused, but more care is needed to see that those which have not been adequately cleansed are removed on leaving the washing plant. A further contribution to cleanliness would be to stop the practice of dumping crates of bottles at street corners, where they are exposed to the elements, insects and dogs. The consumer can also help by the hygienic care of the bottles. They should never be used for any other purpose than to hold milk. After use, they should be well rinsed in cold water to remove any milk residue. Ihe presence of pieces of glass in milk bottles continues to be reported. This glass is usually in the form of chips from the rim of the bottle. This chipping is most iikely to occur during the machine capping of the bottles, but may also happen by rough handling of the bottles during delivery. The solution of the problem of glass chips and dirty bottles would appear to be the replacement of the glass bottle by the non-returnable carton. Ice-Cream.— Under the Food and Drugs Act, premises used for " the sale or the manufacture for the purpose of sale, of ice-cream, or the storage of ice-cream intended for sale" must be registered. This does not apply to premises used primarily as a club, hotel, inn or restaurant and only to a theatre, cinematograph theatre, music hall or concert hall if the ice-cream is manufactured on the premises. The number of premises registered at the end of the year was 219. In recent years, the cleanliness of Ice-cream has given rise to anxiety, and though no bacteriological standard has been laid down, the Ice-Cream (Heat Treatment, etc.) Regulations were brought into operation with a view to improving the hygienic quality. The Regulations require all ice-cream except complete cold-mix powders, to be heat treated with a view to killing any pathogenic organisms which may be present and lay down the temperatures at which mixtures are to be kept before and after heat treatment —these temperatures are such as to discourage bacterial growth. I he Regulations also require that ice-cream shall be protected from dirt, dust or other contamination. 1 he enforcement of these Regulations calls for regular and persistent supervision of premises, plant and methods of manufacture and handling. During the year, 456 inspections of registered premises were carried out. The following results were obtained from the bacteriological examination of the following samples :— Excellent Satisfactory Doubtful Unsatisfactory Ice Cream 62 26 2 1 Water ices or "lollies" 29 21 1 — Milk ices — 2 1 — Rinse water — 1 — — The percentage of doubtful and unsatisfactory samples was 3.4, as compared with 3.6 in 1953, 31.9 in 1952 and 32.5 in 1951. This improvement seems to be due to the fact that most of the ice-cream o d in the Borough is now produced by large firms employing chemists and bacteriologists to check e quality and hygienic condition of their product. 23 Bakehouses.— There are 21 bakehouses in the Borough and 144 visits of inspection were made during the year. Slaughterhouses, etc.— There is no public abattoir or private slaughterhouse operating in the Borough. There is one licensed knacker's yard and the humane killer is used on all animals slaughtered there. During the year, three visits of inspection were made. Slaughter of Animals Act, 1933.— During the year, four applications for a licence as a slaughterman were granted. Inspection of Meat and Other Foods.— There are in the Borough 160 catering establishments, 21 bakeries, 72 butchers' shops, 32 fish shops, 9 milk depots and 365 other retail food premises subject to inspection and supervision. During the year, inspections of food were carried out as follows :—meat, 876; fish, 190; provisions, 508; vegetables and fruit, 170; foodstuffs on hawkers' vehicles or stalls, 174; and other foods, 482. During the year, 8,071 lbs. and 5,588 tins, etc., of unsound food were seized by or surrendered to the Sanitary Inspectors at retail premises. The following foods were brought to the Department because the purchasers were not satisfied of their fitness for human consumption :—bread, three; flour, one; soup, one; cooking fat, one; meat and meat products, six; bacon, one; fruit, one; confectionery, two; and cordial, one. One of these items was sent for analysis and found to be satisfactory. In six cases foreign bodies were found to be present and in four cases the foodstuffs were found to be unsound. Warnings were issued in nine cases and proceedings in the other case resulted in an unconditional discharge with ten guineas costs. In the remaining cases no cause for any action was found. Premises used for "the preparation or manufacture of sausages or potted, pressed, pickled or preserved food for sale" are required under the Food and Drugs Act, 1938, to be registered, and at the end of the year, 95 such premises were registered. Under Section 11 of the Middlesex County Council Act, 1950, hawkers of food and their storage premises require to be registered. At the end of the year, 76 hawkers were on the register. Municipal Restaurants and School Canteens.— There is no municipal restaurant in the Borough, but during the year the 20 school canteens provided 1,291,643 meals. The school dinner is designed to provide about one-third of the child's daily protein requirement, together with a due proportion of other foods. Parents should not depend too much on the school dinner, and other meals at home should be adequate and varied. A detailed inspection of all kitchens, sculleries, stores, etc., in connection with the school meals service was carried out and reports and recommendations submitted. A talk on kitchen hygiene and food poisonine was given to the school canteen staff. Food and Drugs Sampling.—During 1954 the following samples for analysis were taken in the Borough by the Public Control Department of the Middlesex County Council :— No. of Samples No. found unsatisfactory Milk, various 228 11 Almonds 2 — Arrowroot 4 — Butter 7 — Cakes (various) 10 — Coffee and chicory essence 2 — Cooked meats 3 — Cornflour 2 — Cream 8 .—. Drugs 5 -— Fish 16 1 Fish cakes 3 — Flour 2 — Fruit (tinned) 4 — Fruit drinks 2 — Fruit and nuts 1 — Ice cream 13 2 Iced lolly 4 - Jam 6 - Jellies 4 - Liver 9 1 Margarine 1 - Marzipan 1 - Minced meat 5 - Mincemean 1 - Meat pie 1 - Non-brewed condiment 3 - Oranges 10 1 Pickles 4 - Salt 1 - Sausages 6 - 24  No. of Samples No. found unsatisfactory Soups 2 — Suet 1 — Sweets 1 1 Tomato sauce 2 — Victoria plums 11 1 Vinegar 24 — White pepper 3 — Wines and spirits 30 - 442 18 The Chief Officer of the Public Control Department submitted the following comments :— "Of the 11 irregular samples of milk, 10 were in respect of 'new milk' sent by farmers to premises in your Borough. Five samples of ' new milk,' involving two farmers, were found to be slightly deficient in fat, but no action was taken in either case since samples of milk from accompanying churns were found to be satisfactory. The remaining five samples of ' new milk,' all from one farmer, were each found to contain traces of added water. At my request, an inspection was made at the farm by the Oxfordshire County Council and the cause of the trouble was traced and corrected, whereupon no further action was taken. Later samples have been satisfactory. The other sample concerned a bottle of Channel Island milk containing a piece of glass. The retailer was prosecuted and fined £5 and £3 3s. Od. costs. Two samples of ice cream, from different retailers, were both found to be deficient in fat. Subsequent samples, however, were all genuine and no action was taken. The irregular fish sample concerned the sale of Witch fillets for Sole fillets. The retailer was prosecuted and fined £2 and £2 2s. Od. costs. The sale of pigs' liver for lambs' liver resulted in the vendor being prosecuted and fined £1 with £1 Is. Od. costs. In respect of one irregular sample of oranges, which were found to contain thiourea, an unauthorised preservative, an official caution was issued to the importer. One sample of Butter Bon-Bons, which were deficient in butter fat, is still under investigation. The irregular sample of plums concerned the sale of ' Ponds Seedling' plums as ' Victoria ' plums, for which the retailer was prosecuted and fined £3 with £1 lis. 6d. costs." The following work in connection with the inspection and supervision of food in the Borough was carried out by the Public Control Department:— (a) Special Designated Milk.— Three dairymen hold licences as dealer/processors of pasteurised milk. Thirty inspections were made at the premises concerned, whilst 134 samples of pasteurised milk from these sources were submitted for examination and found to be satisfactory. (b) Tuberculosis Examination.— Fifty-one samples of milk were submitted for such examination by animal innoculation. No adverse report was received. (c) Merchandise Marks Act, 1887-1953.— Attention has been paid in particular to compliance with the Imported Food Orders made under the Merchandise Marks Act, 1926. In this connection, the marking of origin of meat, apples, tomatoes, poultry, dried fruit, butter and salmon was checked by 120 inspections, during which 1,641 displays or articles were examined. The only infringements detected were of a minor nature and these were dealt with on the spot. (d) Labelling of Food Order, 1953.— To ensure compliance with this Order, 33 premises were visited and 126 articles of food were examined. No infringement of substance was discovered. 5'ood Hygiene.— The work of promoting sound standards of hygiene in food premises has been steadily pursued. As far as possible, the plans of all premises which will be associated with the preparation and sale of food are examined. In this way it is possible to influence the standard of premises and equipment and consultation on these matters are welcomed. During the year, 1,049 visits of inspection were paid with a view to securing " clean food, handled by clean hands and transported, prepared and stored under clean conditions " and as a result of these visits the following works were carried out Cold water supplies provided, repaired or improved 1 Hot water supplies provided, repaired or improved 12 Water closets provided, repaired or improved 10 Washing facilities provided or improved 15 Ventilation provided or improved 2 Drainage provided or repaired 26 Dustbins provided 6 Yards paved or repaired 4 Walls and ceilings repaired or cleansed 46 Floors repaired 6 Premises cleansed 12 Protection of foodstuffs enforced 16 Equipment repaired or improved 13 Offensive accumulations removed 5 Nuisances abated and other action 8 25 While well designed and equipped premises are important, they only fulfil their real purpose when associated with hygienic habits in their users. Man is the source of most food infections and if he desires clean food he must practice personal hygiene. If every mother obeyed in her kitchen the same rules she wishes to see obeyed in shops and restaurants and brought up her family to obey these rules instinctively, it would mean much for the future. These children will not only be the housewives of the future, but also the future cooks and food handlers. Schools are doing something to teach children to treat food as it should be treated, but the best place for children to be introduced to hygienic habits is at home, where they should be part of the child's natural background. Nutrition.— The surveys carried out throughout the country by the Ministry of Health, school health service records and all available local evidence, show that the standard of nutrition is being maintained and even slowly improved. Under the Welfare (Foods) Scheme of the Ministry of Food, vitamin supplements are available free or at low cost to expectant and nursing mothers and to children under the age of five years. The distribution of these welfare foods is now the responsibility of the local health authorities. Though this now links the scheme closely with the maternity and child welfare services, the use made of these facilities by mothers is far from adequate. Milk is available free to all school children. Meals at a low cost, or free if the family circumstances warrant it, are provided at all schools maintained by the Education Authority. Checks made by the Education Department at various times show, as under, the extent to which advantage is taken of these facilities:— No. of pupils present % taking milk % taking meals October, 1951 12,832 81.1 54.5 February, 1952 12,291 79.7 54.4 June, 1952 12,410 83.9 51.7 October, 1952 13,062 81.8 53.3 June, 1953 12,954 83.5 44.6 October, 1953 13,375 83.2 45.8 Tune, 1954 12,943 83,4 44.3 October, 1954 13,743 81.2 47.2 Gross malnutrition is not seen in this country now, though no doubt there is still much nutritional defect of a lesser degree. There is a growing volume of evidence that such matters as fertility, pregnancy, well-being of the baby developing in the womb, development of teeth and susceptibility to infection are to some extent dependent on the amount and type of food eaten. Quantity of food is not the only consideration in maintaining a good level of nutrition. A careful selection of essential foods in balanced proportions is important. HOUSING Shortage of houses continues to be one of our social problems. The compulsory and prolonged sharing of houses by families causes physical discomfort, but also leads to frustration and discontent. Scarcity of separate accommodation makes the start of family life difficult for the unmarried and the bearing and rearing of children difficult for the married. A house is not fulfilling its true social purpose unless it is also a home and it can seldom be a home if occupied by more than one family. The numbers of new houses erected in the Borough in recent years is shown below:— 1946-50 1951 1952 1953 1954 Heston and Isleworth B.C. 781 220 162 117 23 Brentford and Chiswick B.C. 34 - - - - Southall B.C. 64 - - - - Middlesex County Council - 4 - - — Ministry of Civil Aviation 69 8 - - — Metropolitan Police - - 12 6 — Prison Commissioners - - — — 8 Private enterprise— (o) new houses 115 23 24 27 76 (b) reconstructed after war destruction 184 - 1 - — (c) housing associations — - 50 140 111 (d) additional dwellings by conversion — - — 3 — 1,247 255 249 371 218 What action is to be taken concerning unfit houses is governed by the cost of the necessary works. Unless the house " is capable at reasonable expense of being rendered fit" action must be in the direction of closing or demolition. " Reasonable expense " has never been defined and with restrictions 26 on rents and the high cost of repairs, its interpretation is far from easy. The matters to be taken into consideration in assessing fitness for human habitation have, in the past, been capable of varying interpretations, but Section 9 of the Housing Repairs and Rents Act, 1954, states, " In determining whether a house is unfit for human habitation, regard shall be had to its condition in respect of the following matters, that is to say— (a) repair; (b) stability; (c) freedom from damp; (d) natural lighting; (e) ventilation; (/) water supply; (g) drainage and sanitary conveniences; and (h) facilities for storage, preparation and cooking of food and for the disposal of waste water; and the house shall be deemed to be unfit as aforesaid if and only if it is so far defective in one or more of the said matters that it is not reasonably suitable for occupation in that condition." Thus for the first time a definite standard has been laid down to replace the general guidance contained in the Housing Act, 1936. The action taken on insanitary and unfit dwelling houses during the year is summarised in the following return which has been submitted to the Ministry of Housing and Local Government: — 1. Inspection of Dwelling-houses During the Year : (1) (a) Total number of dwelling-houses inspected for housing defects. (Under Public Health and Housing Acts) 356 (b) Number of inspections made for the purpose 387 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under Housing Regulations, 1925 and 1932 36 (b) Number of inspections made for the purpose 45 (3) (a) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 286 2. Remedy of Defects During the Year Without Service of Formal Notices : Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 281 3. Action under Statutory Powers During the Year: (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 31 (2) Number of dwelling-houses which were rendered fit after service of formal notices : (a) by Owners 25 (b) by Local Authority in default of owners 2 (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : (a) by Owners 4 (b) by Local Authority in default of owners 1 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 22 (3) Number of dwelling-houses rendered fit in consequence of Undertakings given by Owner 7 (4) Number of dwelling-houses in respect of which undertakings from owners accepted, not to relet houses for human habitation Nil (5) Number of dwelling-houses demolished in pursuance of Undertakings 9 (d) Proceedings under section 12 of the Housing Act, 1936: (1) Number of separate tenements, or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 27 (e) Proceedings under section 155 of the Housing Act, 1936: Number of prosecutions taken for letting, attempting to let, occupying or permitting to occupy houses ordered to be closed Nil (/) Housing Act, 1949, and Local Government (Miscellaneous Provisions) Act, 1953: (1) Demolition Orders Quashed 1 (g) Local Government (Miscellaneous Provisions) Act, 1953: (1) Demolition Orders determined and Closing Orders substituted 1 (2) Closing Orders made under section 10 (1) 1 4. Housing Act, 1936—Overcrowding : (1) (a) Number of dwellings overcrowded at the end of the year 45 (b) Number of families dwelling therein 79 (c) Number of persons dwelling therein 368 (2) Number of new cases of overcrowding reported during the year 12 (3) (a) Number of cases of overcrowding relieved during the year 9 (b) Number of persons concerned in such cases 66 (4) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 5. Other Matters : (1) Number of dwelling-houses demolished voluntarily 6 Section 26 of the Housing Repairs and Rents Act, 1954, permits a tenant, on whom a "repairs increase" notice has been served, to apply to the Council for a certificate that either or both of the conditions justifying an increase of rent (in good repair and reasonably suitable for occupation) are not fulfilled and the Council, if satisfied that the house fails to fulfil either or both conditions, must certify accordingly and while such a certificate is in force "no sum shall be recoverable by way of repairs increase." During the year, 29 such certificates were issued. On the application of the landlord, the Council must revoke the certificate if the works necessary to comply with both the conditions justifying an increase in rent have been carried out to their satisfaction. During the year, three certificates were revoked. At the end of the year, the following 36 houses, subject to Demolition or Closing Orders or to undertakings not to re-let till rendered fit, were still occupied :— Situation Date of Demolition Order or undertaking 11, (formerly 15) Wellington Road North 25.10.38 14, Brickfield Yard 25.10.38 16, Brickfield Yard 25.10.38 18, Brickfield Yard 25.10.38 3, Park Cottages 28.12.38 4, Park Cottages 28.12.38 373, Staines Road 28.2.39 11, Tivoli Road 28.2.39 13, Tivoli Road 28.2.39 15, Tivoli Road 28.2.39 106, Linkfield Road 28.3.39 45, Hanworth Road 28.3.39 49, Hanworth Road 28.3.39 17, Inverness Road 28.3.39 98, Linkfield Road 28.3.39 100, Linkfield Road 27.6.39 122, New Heston Road 25.7.39 124, New Heston Road 25.7.39 162, Linkfield Road 30.4.40 3, Richmond Cottages 25.6.40 102, Linkfield Road 22.2.49 721, London Road 29.3.49 8, New Heston Road 31.1.50 10, New Heston Road 31.1.50 12, New Heston Road 31.1.50 14, New Heston Road 31.1.50 159, Martindale Road 25.7.50 161, Martindale Road 25.7.50 165, Martindale Road 25.7.50 67, Pears Road 29.4.52 4, Derby Road 29.7.52 169, Martindale Road 30.9.52 10, South Street 30.12.52 13'3, Grove Road 30.3.54 135, Grove Road 30.3.54 139, Grove Road 30.3.54 28 All these houses are incapable of being made fit at a reasonable cost and their continued occupation is a matter of some concern. The need for new houses continues, but satisfactory housing does not depend on and cannot await the building of new dwellings. The maintenance of existing houses in a habitable condition and the improvement or demolition of sub-standard houses must be pursued to provide a balanced housing programme. Little use has been made locally of the " improvement grants " available to landlords under recent housing legislation. The Housing Department is kept informed of adverse housing conditions coming to the notice of the Health Department. Assistance is given to the Housing Department in the assessment of applications for re-housing where priority is claimed on medical or public health grounds. GENERAL MATTERS Burials.— Under Section 50 of the National Assistance Act, 1948, it is the duty of the Council to arrange the burial of any person who has died in the district, where it appears that there are no suitable arrangements for the disposal of the body. During 1954, two burials were arranged in accordance with this section. Public Mortuary.— The public mortuary is situated on the grounds of Holy Trinity Church. The premises are out-of-date and unsuitable for post-mortem examinations or the retention of a body for other than a very short time, so by arrangement with Acton Borough Council and the Coroner, bodies are taken direct to or transferred to Acton Mortuary. The Council pays a proportion of the cost of the maintenance of the Acton Mortuary. Medical Examination of Staff.— For superannuation or other purposes, 27 members of the Council's staff were referred to the Health Department for medical examination. Health Education.— Posters issued by the Central Council for Health Education continued to be displayed on the boards formerly used by the Empire Marketing Board. During the year, the Medical Officer of Health gave talks to several organisations in the Borough on various aspects of the health services. Though the work of the department is not primarily educational, the staff are fully aware of the opportunities given by their contact with the people for drawing attention to matters bearing on health and hygiene. Other Departments have co-operated by displaying health education material. People will submit to hygienic procedures which do not involve them in any personal effort, but will avoid anything which demands positive action or initiative on their part. This is the real problem of health education, but there are indications that people are beginning to appreciate the importance of personal effort in the maintenance of health. Persons in Need of Care and Attention.— Section 47 of the National Assistance Act, 1948, places the responsibility on the Council of taking action to secure " the necessary care and attention for persons who— (a) are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention." 1 he action to be taken involves application to the Court for an Order for the compulsory removal of the person concerned to the institution or hospital. The National Assistance (Amendment) Act, 1951, shortens the legal procedure for obtaining an Order "if it is certified by the medical officer of health and another registered medical practitioner that in their opinion it is necessary, in the interests of the person, to remove him without delay." Before bringing such cases to the notice of the Council, every effort is made to arrange voluntary admission or for the necessary care to be given by relatives, friends, Despite the growing interest of statutory and voluntary agencies in the welfare of the aged, cases come to the notice of the Department of neglected aged persons living in insanitary conditions. Such persons are usually most reluctant to accept assistance or to go to hospital or institution, but fortunately, >n most cases, peaceful persuasion secures their co-operation in some degree and the necessary action can he taken. In one case only was it necessary to seek authority to apply for an Order, but before the Order could be obtained, the man concerned agreed to go to hospital. Laundry Service.— One of the problems in the care of aged and sick persons in their own homes is soiled clothing and bed linen. Where washing facilities are poor and the persons concerned neither are nor can afford assistance, the cleansing of clothing and bedding presents serious difficulty. In some cases, action under Section 84 of the Public Health Act, 1936, is the only solution and the Council as made arrangements with a laundry firm for the cleansing of articles where the Medical Officer of ealth has issued the certificate required by the Act. The number of cases in which such action has 'een necessary is small, but the provision of these facilities has met a genuine need. 29 TABLE I Summary of Vital Statistics 1895-1954. Estimated Civilian population (mid-year) Birth Rate per 1,000 populalation Death Rate per 1,000 populalation Infant Mortality Rate Deaths under 1 yr. per 1,000 live births Neo-natal Mortality Rate Deaths under 1 mth. per 1,000 live births Maternal Mortality Rate per 1,000 live and still births Still Birth Rate per 1,000 live and still births Tuberculosis Death Rate per 1,000 population 1895 27,895 30.9 17.2 125 - - - 1.4 1896 28,352 27.9 14.5 151 — - — 1.2 1897 28,765 25.3 13.6 132 — - — 1.6 1898 29,185 28.0 16.0 173 — - — 1.4 1899 29,607 31.4 17.8 155 — - — 2.2 1900 30,040 27.1 23.0 156 — - — 1.6 1901 30,959 28.5 15.7 160 — - — 1.6 1902 31,470 29.9 16.7 157 — - — 1.3 1903 31,531 32.8 14.2 99 — - — 1.8 1904 32,630 32.3 16.8 169 — - — 1.9 1905 33,194 31.0 13.9 137 — - — 1.2 1906 33,767 33.5 15.1 139 48 - — 1.3 1907 34,351 33.0 14.2 88 30 - — 1.2 1908 34,895 29.1 15.9 111 29 - — 1.3 1909 35,672 27.3 15.9 91 28 - — 1.6 1910 36,311 25.1 . 14.1 100 26 - — 1.3 1911 43,684 23.9 13.6 162 43 - — 1.5 1912 45,191 23.1 10.8 86 37 - — 0.4 1913 46,749 24.0 11.7 103 34 - — 0.9 1914 48,361 21.0 11.4 98 34 - — 1.2 1915 41,836 19.6 12.5 102 40 - — 1.6 1916 42,000 20.1 12.6 77 30 - — 1.2 1917 40,000 16.6 14.9 117 47 - — 1.8 1918 43,129 16.8 17.9 86 36 - — 1.8 1919 42,020 16.8 11.6 99 52 - — 1.0 1920 43,445 24.7 10.9 58 22 - — 1.0 1921 47,290 20.0 11.3 69 40 - — 1.0 1922 47,850 18.7 11.8 74 37 - — 1.0 1923 48,030 17.5 9.8 55 26 - — 0.9 1924 47,700 17.7 10.8 61 27 - — 1.0 1925 48,620 17.4 10.3 73 41 - — 0.7 1926 52,110 17.4 9.1 56 25 - — 0.8 1927 55,870 16.1 10.7 68 36 - — 1.0 1928 59,730 17.1 9.9 56 27 - — 0.6 1929 63.070 17.1 11.5 46 18 - — 0.8 1930 63,070 19.1 9.6 50 25 6.4 36 0.8 1931 76,230 17.6 10.0 49 24 5.0 30 0.7 1932 81,100 17.4 9.7 60 29 2.8 24 0.7 1933 84,460 16.3 9.4 43 19 4.9 34 0.9 1934 87,797 15.1 10.3 48 21 2.9 32 0.8 1935 90,970 15.8 9.0 41 22 4.7 36 0.6 1936 95,000 15.7 9.6 48 20 2.0 30 0.6 1937 99,420 14.9 9.5 40 20 3.3 23 0.5 1938 101,500 14.2 8.6 46 24 2.7 30 0.6 1939 101,100 15.0 8.8 50 23 3.4 26 0.7 1940 97,530 13.7 12.3 58 39 2.3 25 0.6 1941 93,990 12.9 10.3 61 32 2.4 35 0.8 1942 95,600 14.6 10.2 72 43 2.8 32 0.7 1943 95,080 16.3 10.6 47 23 0.6 26 0.5 1944 92,370 16.5 10.4 46 30 1.9 22 0.5 1945 95,100 15.5 9.7 51 33 2.0 26 0.5 1946 104,240 17.3 10.4 29 22 2.2 26 0.5 1947 106,670 17.3 10.5 39 24 0.5 24 0.5 1948 106,200 14.5 8.8 30 20 0.6 25 0.4 1949 106,900 13.6 9.8 17 12 2.0 18 0.3 1950 107,300 11.6 9.9 24 14 0.8 18 0.3 1951 106,400 11.3 10.4 18 14 0.0 20 0.3 1952 105,600 11.7 10.1 19 15 0.0 26 0.2 1953 105,100 12.1 10.1 18 11 0.8 19 0.1 1954 105,60!) 112 6 26 19 0.0 20 0 I 30 TABLE II REGISTRAR-GENERAL'S RETURN OF CAUSES OF DEATH, 1954 Abridged List No. Cause of Death Male Female Total B 1 Tuberculosis, respiratory 8 4 12 B 2 Tuberculosis, other - 1 1 B 3 Syphilitic disease 2 — 2 B 8 Diphtheria — — — B 9 Whooping Cough — — — B 10 Meningococcal infections — —• —• B 12 Acute poliomyelitis — — — B 14 Measles — - — B 4-7,11, 15-17 Other infective and parasitic diseases 1 1 2 B 18 Malignant neoplasm, stomach 17 14 31 Malignant neoplasm, lungs 45 A 49 Malignant neoplasm, breast — 28 28 Malignant neoplasm, uterus — 7 7 Other malignant and lymphatic neoplasms 50 55 105 Leukaemia, aleukaemia 2 2 4 B 20 Diabetes 2 4 6 B 22 Vascular lesions of nervous systems 53 69 122 B 26 pt. Coronary disease, angina 93 48 141 B 28 Hypertension with heart disease 12 14 26 B 25 26 pt. 27 Other heart disease 48 72 120 B 29 46 pt. Other circulatory disease 24 38 62 B 30 Influenza 1 1 2 B 31 Pneumonia 16 15 31 B 32 Bronchitis 39 23 62 B 46 pt. Other respiratory diseases 3 3 6 B 33 Ulcer of stomach and duodenum 9 1 10 B 36, 43 pt. Gastritis, enteritis, diarrhoea 2 2 4 B 38 Nephritis and nephrosis 5 2 7 B 39 Hyperplasia of prostate 9 — 9 B 40 Pregnancy, childbirth, abortion — — —. B 41 Congenital malformations — 5 5 Residial Other defined and ill-defined diseases 61 53 114 BE 47 Motor vehicle accidents 7 6 13 BE 48 All other accidents 14 10 24 BE 49 Suicide 6 7 13 BE 50 Homicide and operations of war — — — Total 529 489 1,018 31 TABLE III INFANTS' DEATHS ACCORDING TO AGE AND CAUSE, 1954 Cause of Death Age Total Days Months jnder 1 1 2 3 4 5 6 7-13 14-20 21-28 1 2 3 4 5 6 7 8 9 10 11 Pneumonia - - - - 1 - - - - - 1 1 - - - - - - - - 1 4 Bronchitis - - - - - - - - - - - - - 1 - - - - - - - 1 Intussusception - - - - - - - - - - - - - 1 - - - - - - - 1 Birth injuries 2 - - - - - - - - - - - - - - - - - - - - 2 Atelectasis & birth asphyxia 4 1 - - - - - 1 - - - - - - - - - - - - - 6 Congenital malformations 2 - - 1 - - - 1 - - - - 1 - - - - 1 - - - 6 Prematurity 4 1 1 1 - - - - - - - - - - - - - - - - - 7 Umbilical Sepsis — — — — — — — 1 — — — — — — — — — — — — 1 Gastro-Enteritis - - - - - - - - - - - - - - - - - - - 1 — 1 Hemorrhagic Disease 1 - - - - - - - - - - - - - - 1 - - - - - 2 TOTAL 13 2 1 2 1 — — 3 — — 1 1 1 2 — 1 — 1 — 1 1 31 32 TABLE IV. CAUSES OF DEATH ACCORDING TO AGE AND SEX, 1954. Cause Groups All Ages Age in Years Under 1 1-2 2-3 3-4 4-5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85 & over M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F Tuberculosis of respiratory system 8 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 - 4 1 1 - 1 - — - - 1 - — Tuberculosis, other forms — 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Syphilis and its sequele 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery, all forms - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet fever and streptococcal sore throat - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Whooping cough - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plauge - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute POlimyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Small-pox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus and other rickettsial diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Other infective and parasitic diseases 2 1 - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - 1 Malignant neoplasms—stomach 17 13 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - 2 2 2 3 2 2 3 1 2 1 2 lungs 42 5 - - - - - - - - - - - - - - - - - - - - - - 1 - - 1 3 - 10 - 5 1 14 1 2 — 4 2 2 — 1 — — — breast — 28 — — — — - - - - - - - - - - - - - - - - - - - - 3 - 2 - 3 — 7 — 3 — 2 — 1 — 3 — 2 — 1 — 1 Uterus - 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 2 - - - 1 - - - 3 - - - - - - other sites 55 55 - - - - - - - - - 1 - - - - - - 1 - 1 - 1 1 - - 2 1 1 4 4 6 4 7 7 9 8 5 10 5 10 4 4 8 2 4 leukaemia, etc. 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - Benign and unspecified neoplasms - 2 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diabetes 2 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 — 2 — 1 — — Anaemias 1 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - Vascular lesions affecting central nervous system 54 75 - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - 2 1 3 2 2 4 5 9 6 5 9 6 8 18 12 20 5 10 Non- meaningococcal meaningtis 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - Rheumatic fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chronic rheumatic heart disease 10 14 — — — — — — — — - - - - - - - - - 1 - - - - - - - 2 2 1 — 1 2 — 1 1 — 1 3 1 2 3 — 2 — 1 Arteriosclerotic and degenerative heart disease— coronary disease, angina 93 50 - - - - - - - - - - - - - - - - - - - - - - - - 2 - 4 1 4 2 10 4 18 2 12 8 1 ) 11 13 8 7 10 4 4 other 46 55 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4 3 4 1 5 3 8 8 10 14 15 26 Other diseases of the heart 6 12 - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - - 2 2 2 3 1 4 1 1 Hypertension with heart disease 13 15 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 1 - - 3 1 1 6 3 5 3 2 1 — Hypertension without mention of heart 2 6 - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - 1 — 1 1 2 — 1 — 1 — — Influenza 1 2 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - 1 Pneumonia 17 15 3 1 - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 - 1 1 1 — 1 — 4 2 3 2 2 2 — 7 Bronchitis 39 24 1 - - - - - - - - - - - - - - - - - - - - - - 1 - - 1 1 - 2 4 — 6 — 5 2 5 2 10 6 3 4 4 6 Ulcer of stomach and duodenum 7 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 1 1 — 1 — — — Appendicitis 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - Intestinal obstruction and hernia 7 3 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - 1 1 1 — 2 1 — — — — Gastritis, enteritis, colitis, etc. 2 2 1 — - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — 1 — — Cirrhosis of liver 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - 1 - - 1 - - - - - Nephritis and nephrosis 4 5 - - - - - - - - - - - - - - - - - - - - - - 1 1 - - 1 - 1 - - 1 - 1 - - - 1 1 - - 1 - - Hyperplasia of prostrate 8 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - 1 - 3 - 2 - - - Complications of pregnancy, childbirth and puerperium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Congential malformation - 5 - 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - Birth injuries, post-natal asphyxia, atelectasis 6 2 6 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Infections of the new born - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Immaturity and other diseases peculiar to early infancy 3 6 3 6 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Senility, ill-defined and unknown causes—sen ility 16 14 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 — 7 4 6 10 —ill-defined causes — 1 - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Other circulatory diseases 4 17 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - 2 1 - 1 - - - 3 1 5 — 5 — 1 Other respiratory diseases 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 1 — — — — All other diseases 25 19 - 1 - - 1 - - - - - - - - - - - - - - - - - 2 - - 1 3 2 2 1 1 1 1 1 2 — 2 3 5 2 3 3 3 4 Motor vehicle accidents 7 6 - - - - - - - - - - - - 1 - 2 - - - - - - 1 1 1 1 1 - - - 1 - 1 - - - - 2 1 - - - - - - All other accidents 14 9 - - - - - - - - 1 - - - - - 1 - - - 1 - 1 - - - 1 - 1 - 1 - - - 2 1 - - - 1 1 3 1 2 3 2 Suicide 6 7 - - - - - - - - - - - - - - - 1 - 1 1 1 - 1 - - - - - 1 2 - 1 - - - 1 1 1 1 - - - - - - Self-inflicted injury - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Homicide - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Operation of war - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ALL CAUSES 527 495 17 14 - 2 l 1 1 — 1 1 — 1 1 — 3 1 2 3 3 2 5 3 6 6 6 9 21 16 39 28 38 26 68 39 50 30 78 64 83 77 59 91 45 81 1,022 31 2 2 1 2 i 1 4 5 5 8 12 15 37 67 64 107 80 142 160 150 126 Percentage of total deaths from all causes 3.03 10.19 0.19 0.10 0.19 0.10 0.10 0.39 0.49 0.49 0.78 1.17 1.48 3.62 6.56 6.26 10.47 7.83 13.89 15.66 14.68 12.33 TABLE V INFECTIOUS DISEASES—1954—AGE DISTRIBUTION Disease Total Under lyr. lyr. 2 yrs. 3 yrs. 4 yrs. 5-9 yrs. 10-14 yrs. 15-19 yrs. 20-34 yrs. 35-44 yrs. 45-64 yrs. 65 yrs. + Cases admitted to hospital Smallpox — — — — — — — — — — — — — — Typhoid Fever — — — — — — . — — — — — — — — Para-Typhoid Fever 1 — — — 1 — — — — — — — — 1 Scarlet Fever 71 — 1 5 5 7 42 8 1 1 — 1 — 15 Diphtheria — — — — — — — — — — — — — — Erysipelas 17 — — — — — — — 1 3 — 9 4 4 Puerperal Pyrexia 33 — — — — — — — 7 21 5 — — 32 Ophthalmia Neonatorum - - - - - - - - - - - - - - Acute Poliomyelitis and polioencephalitis — — — — — — — — — - - - - - Meningoccal Infection 4 — 2 — — — 1 — 1 — — — — 4 Pneumonia 34 3 1 2 1 — 5 — 1 1 1 12 7 11 Malaria 2 — — — — — — —• — 1 1 — — — Dysentery 9 — 1 — 1 — 1 1 1 2 - 1 1 6 Measles 38 1 2 7 7 3 17 1 — - — — — — Whooping Cough 35 2 5 3 4 7 12 1 — - 1 — — 2 Food Poisoning 48 3 — 2 — 1 7 1 1 8 7 15 3 4 Tuberculosis:— Pulmonary TSIon \ ,111 81 — 2 — — l 3 4 3 26 17 18 7 34 NOTIFICATIONS AND DEATHS FROM CERTAIN INFECTIOUS DISEASES TABLE VI HESTON AND ISLEWORTH, 1935-1954 Year Smallpox Scarlet Fever Diphtheria Erysipelas Pneumonia Men ingococcal Infection Epidemic Encephalitis Poliomyelitis and Polioencephalitis *Typhoid Fever Paratyphoid Fever Dysentery Measles Whooping Cough Influenza Tuberculosis Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1935 - - 213 1 72 3 25 - 116 39 1 1 2 5 - - 4 — — — - - — — — - Not Notifiable 1 129 53 1936 — - 224 - 21 2 51 - 70 43 1 — — — 1 1 2 — — — — — 2 — 2 8 112 61 1937 — - 242 1 18 1 45 - 124 41 5 1 — 1 — 1 6 — — — — — 1 — 1 38 102 53 1938 — - 314 - 40 2 43 - 159 36 8 5 1 — 3 1 4 — — — 2 — 2 — 1 6 113 58 1939 — - 175 - 51 5 23 - 142 35 6 — — 2 — - 3 — — — 1 — — — 2 10 132 69 1940 — - 96 - 73 5 35 1 200 57 43 6 1 2 1 - 4 - 1109 2 123 3 16 130 59 1941 — - 117 - 37 3 20 - 124 41 34 2 1 1 1 - 2 — 30 — — 2 580 — 286 1 9 174 78 1942 — - 190 - 11 1 16 - 72 67 12 1 — — — - 4 — 1 — 2 2 1085 2 243 4 3 202 70 1943 — - 280 - 5 — 21 - 116 63 — 1 — 1 — - 1 — — — — — 636 1 134 1 16 190 49 1944 — - 130 - 11 1 16 - 50 59 3 2 — 1 3 - — — — — 22 — 219 — 171 3 5 184 44 1945 - 124 - 24 2 16 1 25 37 11 2 1 — 7 - - - - - 28 — 1107 1 110 — 3 157 52 1946 — - 67 - 16 1 19 1 47 53 13 — — 1 1 1 1 — — — 6 — 170 — 170 — 16 217 56 1947 — - 62 - 3 — 19 - 56 40 8 1 — — 43 5 1 840 2 142 2 8 180 52 1948 — - 159 - 2 — 21 - 41 42 2 — — 1 29 2 — — 3 — 5 — 571 — 227 — 5 168 43 1949 — - 138 - - — 26 - 52 53 2 1 — 2 14 1 — — — — 2 — 523 — 173 — 6 219 36 1950 — - 92 - 1 — 12 - 64 30 — — — — 9 — 3 — 6 — 6 — 881 — 206 — 6 182 37 1951 — - 67 - - — 12 - 59 38 5 1 — — 4 — 1 — 1 — 77 — 790 1 220 — 33 185 27 1952 — - 161 - - — 19 1 58 51 5 1 — — 3 — — — 7 — 28 — 1027 — 86 — 4 168 19 1953 — - 161 - - — 16 - 78 48 1 — — — 11 — — — — — 13 — 602 — 291 — 26 141 10 1954 — - 71 - - — 17 - 34 31 4 —— — — - — — — 1 — 9 — 38 — 35 — 2 88 12 * Includes para typhoid fever to 1939. 35 TABLE VII. COUNTY OF MIDDLESEX. CERTAIN VITAL STATISTICS FOR THE YEAR 1954. District Population mid-1954 Birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 popu lation Infant mortality per per 1000 live births Maternal mortality per 1000 total births Crude Adjusted Crude Adjusted Pulmonary: tuberculosis Cancer Infant Neo-natal Acton 67,150 14.5 13.5 9.7 9.5 0.16 2.0 17.4 11.3 Brentford & C-hiswick 59,160 13.6 12.6 11.2 10.6 0.07 2.7 26.2 18.7 — Ealing 185,000 12.5 12.0 9.5 10.0 0.10 2.1 14.2 11.2 — Edmonton 100,300 12.6 12.0 8.0 8.9 0.12 1.8 15.8 11.9 0.77 Enfield 109,200 12.6 12.5 11.3 12.2 0.16 2.4 17.4 14.5 — Feltham 48,200 15.8 15.6 5.9 8.7 0.10 1.4 17.1 13.2 1.30 Finchley 70,030 12.5 11.9 10.7 9.5 0.09 2.2 18.2 14.8 1.12 Friern Barnet 28,680 9.6 10.1 15.1 14.2 0.24 2.3 21.9 18.2 — Harrow 217,700 12.6 12.9 8.3 9.5 0.13 1.7 16.7 11.3 0.71 Hayes & Harlington 64,960 14.4 13.5 7.1 10.7 0.15 1.5 21.4 19.2 — Hendon 154,800 13.0 12.2 9.0 9.4 0.07 1.9 20.9 16.9 0.98 Heston & Isleworth 105,600 11.2 11.1 9.6 9.9 0.11 2.1 26.2 18.6 — Hornsey 98,210 13.8 12.7 10.3 9.1 0.18 2.2 19.2 15.5 1.45 Potters Bar 17,620 14.0 13.4 7.4 8.3 0.06 1.8 12.1 8.1 — Ruislip & Northwood 72,070 12.7 12.8 7.6 8.9 0.06 1.7 20.8 9.9 1.08 Southall 54,440 12.9 12.8 12.2 13.1 0.22 2.1 18.5 14.3 1.41 Southgate 72,290 11.3 12.3 11.2 8.8 0.08 2.4 16.0 14.7 1.21 Staines 41,050 17.0 16.3 7.8 8.7 0.10 1.7 18.7 12.9 — Sunbury 24,460 18.8 17.7 9.0 10.1 0.04 1.7 13.0 6.5 2.15 Tottenham 123,200 12.4 11.8 9.6 9.9 0.19 2.0 17.7 12.5 0.64 Twickenham 104,700 12.7 13.0 11.1 10.2 0.21 2.1 14.3 12.8 — Uxbridge 56,840 16.6 15.4 8.6 10.2 0.05 1.8 26.6 20.2 1.05 Wembley 129,500 11.4 11.4 8.6 9.5 0.12 1.8 18.2 14.2 0.66 Willesden 177,300 14.7 13.2 8.9 9.6 0.19 1.9 19.2 14.2 — Wood Green 51,090 11.0 10.8 10.4 9.6 0.12 2.2 26.6 17.7 — Yiewsley&W. Drayton 22,450 20.0 18.4 8.0 10.3 0.04 1.5 26.7 24.4 — County 2,256,000 13.1 12.7 9.4 9.9 0.13 2.0 18.8 14.2 0.53 36 TABLE VIII (a) METEOROLOGY (Extracted from records supplied by Chief Engineer, Mogden Sewerage Works.) Week ended Barometer Temperature (°F) Days with Rainfall Total rainfall (inches) Highest Lowest Max. Min. January 2nd 30.68 30.27 48 33 6 0.29 9th 30.59 29.99 45 27 5 0.14 16th 30.31 29.23 59 34 5 0.47 23rd 30.60 30.03 38 28 2 0.28 30th 30.40 29.62 38 21 3 0.01 February 6th 30.51 29.43 38 19 2 0.05 13 th 29.77 29.26 53 30 7 0.71 20th 30.30 29.56 52 31 5 0.82 27th 30.29 29.24 57 34 7 0.84 March 6th 29.71 28.71 50 22 6 1.14 13 th 30.07 29.40 64 33 4 0.10 20th 30.23 29.56 67 35 4 0.26 27th 30.16 29.41 62 33 3 0.09 April 3rd 30.01 29.51 60 37 7 0.94 10th 30.53 29.96 60 31 3 0.02 17th 30.67 30.31 60 34 1 Trace 24th 30.67 30.15 57 42 1 Trace Mav 1st 30.31 29.21 63 36 1 0.19 8th 30.28 30.20 66 36 5 0.45 15 th 30.16 29.99 78 45 3 0.34 22nd 30.36 29.87 68 38 3 0.06 29th 30.12 29.86 82 43 7 0.77 June 5th 30.25 29.70 74 48 2 1.33 12 th 29.93 29.21 68 49 7 2.66 19th 30.29 29.77 72 48 5 0.13 26th 30.19 29.70 75 47 3 0.22 July 3rd 30.32 29.54 67 45 6 0.17 10th 30.21 29.57 70 43 6 0.39 17th 30.16 29.28 72 49 3 0.67 24th 30.31 29.45 76 50 1 0.01 31st 30.01 29.44 68 51 5 1.23 August 7 th 29.94 29.50 79 52 3 1.46 14th 29.87 29.28 72 51 6 1.43 21st 30.10 29.83 70 47 6 0.53 28th 30.27 29.88 77 48 3 0.35 September 4th 30.28 30.02 86 46 2 0.29 11th 30.09 29.70 70 47 7 0.29 18th 30.00 26.62 67 44 5 0.52 25th 30.26 29.50 69 38 5 0.44 October 2nd 30.28 29.71 63 39 5 0.19 9th 30.44 29.95 70 38 5 0.38 16th 30.40 29.80 65 37 3 0.02 23 rd 30.11 29.06 69 42 7 0.50 30th 30.03 29.05 67 30 4 0.56 November 6th 30.17 29.62 62 39 6 1.06 13 th 30.27 29.38 61 33 6 0.46 20th 30.63 30.02 52 30 5 0.13 27th 30.02 28.77 57 34 7 1.29 December 4th 30.54 29.06 58 38 6 0.92 11th 30.25 28.36 49 24 5 1.84 18th 30.46 29.18 55 31 6 0.14 25th 30.34 29.76 54 33 3 0.04 37 TABLE VIII (b) WIND DIRECTION (Sum. of Daily Records, 52 weeks) N 15 days N.N.E 13 days N.E 24 days E.N.E 4 days E 5 days E.S.E 3 days S.E 3 days S.S.E 3 days S 12 days s.s.w 12 days s.W 73 days w.s.w 25 days w 28 days W.N.W 11 days N.W 18 days N.N.W 8 days Calm 107 days 38 TABLE IX FACTORIES ACTS, 1937 and 1948 PART I OF THE ACT 1. Inspections for purposes of provisions as to health made by Sanitary Inspectors Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 41 101 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 356 711 21 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 6 10 1 — TOTAL 403 822 23 — 2. Cases in which Defects were found— Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) - - - - - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7)— (o) insufficient 2 1 — 1 — (b) unsuitable or defective 21 22 — 3 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — TOTAL 23 23 — 4 — 39 Printed by HADOEN, BEST & Co., Ltd. 16, Strutton Ground. London, S.W.I.